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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 /> retained by tank owner.This checklist will be required and must be provided to CSI when making a 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 /> MMM M' <br /> Completed N/A <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 6. <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 11. <br /> 10. Tanks ballasted according to Section 10. <br /> 11. Tank burial depth complies with the requirements of Section 8. <br /> 12. Piping and bottom sump clearances according to Section 13. <br /> 13. All piping connections are flexible connections according to Section 13. <br /> Installation was in accordance with Tank Installation Instructions 11 6001). <br /> Owner Representative(Print Name) Date Contractor Representative(Print Name) Date <br /> Olgltaliy elgnetl by S—A— <br /> °= sae5s�°Ads <br /> Scott Alves �a= <br /> 2D22�23 14 30 D7 00 <br /> Owner Representative(Signature) Date Contractor Representative(Signature) Date <br /> 30 <br />