Date

Company Name

Contact Person

Street Address

City, State, Zip

Delivery Address (if different)

Delivery City/State

Email Address

Phone     Fax

Project Name

TANK INFORMATION

Tank Style
Vertical     Safe-Tank     Imfo     Horizontal     Cone Bottom
Other

Tank Size
Gallons     Diameter Feet  Inches       Height Feet  Inches

Tank Construction
Cross-linked     Cross-linked w/OR1000 Liner     Linear     Fiberglass
Other

Tank Pressure
All tanks are designed for atmospheric pressure only.

Tank Color
Natural     Black     Other

Tank Use
Indoor     Outdoor

Chemical Being Stored
Name
Concentration or %     Specific Gravity
Maximum Temperature

Fittings  (Type, Size, Position, Flanged)

Inlet Outlet     Vent Level

Size     Side  Top    Flanged?   Yes   No Size     Side  Top    Flanged?   Yes   No Size     Side  Top    Flanged?   Yes   No Size     Side  Top    Flanged?   Yes   No

Other 1     Size     Side  Top    Flanged?   Yes   No
Other 2     Size     Side  Top    Flanged?   Yes   No
Other 3     Size     Side  Top    Flanged?   Yes   No
Other 4     Size     Side  Top    Flanged?   Yes   No
Other 5     Size     Side  Top    Flanged?   Yes   No

Special Instructions Regarding Fittings

Flexible Connections?   Yes   No   Flexible connections are required to preserve warranty; allow for tank expansion/contraction and to reduce pump/piping vibration stress on the tank.

Wind and/or Seismic Restraint System?
Yes   No

Additional Notes or Comments