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
Above Ground Vertical     Buriable Underground Cistern     Horizontal     Rectangular
Other (please explain)

Tank Size
Gallons     Diameter Feet  Inches       Height Feet  Inches

Tank Pressure
All tanks are designed for atmospheric pressure only.

Tank Color
Natural     Black     Other

Use
Indoor     Outdoor

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

Wind and/or Seismic Restraint System?
Yes   No

Heat Trace and Insulation
Yes   No     If yes, what temperature to maintain.

Additional Notes or Comments