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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 i%tallation 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 ofl <br />Installation / <br />Site Address <br />Street City <br />State <br />Zip <br />Installing Contractor tcfi7lA�s�`'� t",er.-<7Ei'� f%fl�Y;Ae •�^,r!.r` tPf` `''.�1'd�✓'.f �^�' <br />e�y$a�" <br />Company Street City <br />State <br />Zip <br />Completed <br />N/A <br />I. Installation backfill material meets CSI specification (sieve analysis is attached). <br />Indicate which material you used: 91 Pea Gravel <br />❑ Crushed Stone <br />❑ Other (CSI approval letter attached) <br />2. Backfill above tank top. <br />Indicate which material you used: It Same backfill material as # 1 above <br />✓ <br />❑ Geotextile and alternative material above tank top <br />3. Excavation and tank clearance meet requirements of Section 6. <br />✓ <br />4. Geotextile used to line excavation: ❑ Yes 91 No <br />�- <br />5. Indicate hole condition: , <br />11 Dry hole (Water is not anticipated to reach tank — area is not subject to flooding) <br />✓'� <br />❑ Wet hole (Excavation may trap water — area is subject to flooding) <br />6. Anchoring performed in accordance with installation instructions: <br />�✓ <br />Indicate which method you used 6B Deadmen <br />❑ Anchor Pad <br />❑ No mechanical anchoring <br />7. Depth of backfill under tank /c�- 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 />y' <br />11. Tank burial depth complies with the requirements of Section B. <br />12. Piping and bottom sump clearances according to Section 13. <br />13.; All piping connections are flexible connections according to Section 13, <br />v% <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 (Si atur Date 30 Contractor Representative (Signature) Date <br />