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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 as warranty claim. <br /> Site Owner P 'A 2ef Date of Installation Qc— L 6y- 2—3,2W Zq <br /> SliteAddress ` 03(o 1 korrcKrt pc) 5+bcG hin <br /> Street City State Zip <br /> � Cd> f► hx(s 32 0(, L"uu" Dr Installing Contractor lowh a►,,) C >Jvt � L vlc.ko 6�)DVlx Ca q Z <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 J <br /> ❑ Crushed Stone <br /> ❑ Other(CSI approval letter attached) <br /> 2. Backfill above tank top. <br /> Indicate which material you used: $L 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: 9—Yes ❑ No � <br /> S. Indicate hole condition: <br /> tt-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 14--Deadmen <br /> ❑ Anchor Pad <br /> ❑ No mechanical anchoring <br /> 7. Depth of backfill under tank 12 inches <br /> 8. All deflection measurements are recorded on reverse side. - <br /> 9. Backfiil 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(INST.60,011)). J f ' J q •�,J <br /> L AU►'\ 4. 114A a- XhJ LGtr Iola? <br /> Owner Representative(Print Name)(/ Date Contractor Representativ (PrintName) Date <br /> oot��,� )J, 9,w t Y <br /> fwm"er Repr ative(Sig t re) Date ontrac res ative(Signat Date <br /> 30 <br />