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0 0 <br /> rNTAINMENT Tank Installation list <br /> LUTIONS For Fiberglass Underground Tanks <br /> The completed checklist and copies of any written authorizations for variations and/or deviations received from CSI, <br /> should be retained by the tank owner and provided later to CSI to validate any future warranty claim. <br /> Site Owner Date of Installation <br /> Site Address <br /> Street City State Zip <br /> Installing Contractor <br /> Company Street City State Zip <br /> Completed NIA <br /> 1. Installation backfill material meets CSI specification(sieve analysis is attached). <br /> Indicate which material you used: ❑ Pea Gravel <br /> ❑ Crushed Stone <br /> ❑ Other(CSI approval letter attached) <br /> 2. Backfill above tank top. <br /> Indicate which material you used: ❑ Same backfill material as#1 above <br /> ❑ Geotextile and alternative material above tank top <br /> 3. Excavation and tank clearance meet requirements of Section E. <br /> 4. Geotextile used to line excavation: ❑ Yes ❑ No <br /> 5. Indicate hole condition: <br /> ❑ Dry hole(Water is not anticipated to reach tank—area is not subject to flooding) <br /> ❑ Wet hole(Excavation may trap water—area is subject to flooding) <br /> 6. Anchoring performed in accordance with installation instructions: <br /> Indicate which method you used ❑ Deadmen <br /> ❑ Anchor Pad <br /> ❑ No mechanical anchoring <br /> 7. Depth of backfill under tank inches <br /> 8. All deflection measurements are recorded on reverse side. <br /> 9. Backfill placed in 12"lifts&probed as described in Section I. <br /> 10. Tanks ballasted according to Section I. <br /> 11. Tank burial depth complies with the requirements of Section G. <br /> 12. Piping and bottom sump clearances according to Section K. <br /> 13. All piping connections are flexible connections according to Section K. <br /> Installation was in accordance with Tank Installation Instructions(INST.6001). <br /> Owner Representative(Print Name) Date Contractor Representative(Print Name) Date <br /> Owner Representative(Signature) Date Contractor Representative(Signature) Date <br />