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Tank Installation Checklist <br /> For Fiberglass Underground Tanks <br /> The tank installation checklist, these instructions, and any correspondence related to the tank Installation must be <br /> t�retained by tank owner. This checklist will be required and must be provided to CSI when making a warranty claim. <br /> Site Owner -� Q w�� �� � '� � �tg' r `a. Date of Installation g4zlz <� <br /> SheAddress ^ VQ t� ^ eAemC,L! <br /> Pp Street //'� City {� State ` Zip <br /> � <br /> Installing Contractor � /AI/M OC1� l4UN k' J C.ertLlot, ws 3206 /YYJNk 7A �tDR P ���I/r+ <br /> Company --v— Street '�rlv� �t ry �— State Zip <br /> Completed N/A <br /> 1. Installation backfill material meets GSI specification (sieve analysis is attached). = <br /> Indicate which material you used: A 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 n1 above <br /> ❑ Geotextile and alternative material above ta(tktop <br /> 3. Excavation and tank clearance meet requirements of Section 6. r� <br /> 4. Geotextile used to line excavation: Yes ❑ No <br /> S. Indicate hole condition: <br /> $L Dry hole (Water is not anticipated to reach tank - area is not subject to flooding) <br /> ❑ Wet hole (Excavationmaytrapwater - areaissubjecttoflooding) <br /> 6. Anchoring performed in accordance with installation instructions: <br /> Indicate which method you used j, Deadmen '.. <br /> ❑ Anchor Pad <br /> ❑ No mechanical anchoring <br /> 7. Depth of backfill under tank finches <br /> 8. All deflection measurements are recorded on reverse side. A <br /> 9. Backfill placed in 12" lifts & probed as described in Section 11 . <br /> 10. Tanks ballasted according to Section 10. <br /> 11 . Tank burial depth complies with the requirements of section 8. Xtc` <br /> 12. Piping and bottom sump clearances according to Section 13. — 1 (L <br /> 13. All piping connections areflexible connections according to Section 13. "t �- <br /> EM <br /> Installation was in accordance with Tank Installation Instructions (INST. 6001 ). 4 -{9-- <br /> ci <br /> Owner Representative (Print Name) Date Contra r Representative ( 4 Date ` <br /> Yl �.9 /h� 5 / <br /> d 2Z</ <br /> 9 <br /> Owner Representative (Signature) Date 30 Contract Representative (Sig ature) Date <br />