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ni__I `C M VE <br /> �fi SIA '�b J �'C di ♦i (L �b J� ��� �!� / <br /> �_ i i1C. 7{� 71� TIC. 1 7F Q� � . /♦ A`. P Ji <br /> 1: <br /> CERTIFICATE K <br /> OF INSTALLATION <br /> FOR THE <br /> ri =lC <br /> PLASTEEL° COMPOSIT UNDERGROUND <br /> TANKRUM <br /> :!! In compliance with part 280 of Title 40 of the Code of PLASTEEL® TANK DATA ._t: <br /> '1�• Federal Regulations,this document may be implemented to <br /> meet Subpart B.paragraph 280.2(e),CERTIFICATION OF The U.L.Label and serial number is on the top centerline of the <br /> INSTALLATION. tank and also listed on the delivery document. <br /> �L <br /> SIZE IN GALLONS TYPE(DW OR SWI U.L.SERIAL NUMBER <br /> The installer must initial all sections below representing <br /> that the installer has read, was cognizant of and has com- <br /> :N-11 pleted. as applicable, all sections of the PLASTEEL® <br /> '1`' COMPOSIT Tank Installation Instructions attached hereto. <br /> INSTALLATION CHECK-OFF <br /> COMPLETION LIST INSTALLATION COMPANY <br /> =!= r <br /> SECTION INITIAL DATE 71; <br /> ej <br /> I.GENERAL <br /> NAME <br /> •�!/ 11.VISUAL INSPECTION <br /> III. HANDLING _ _ ADDRESS <br /> IV. EXCAVATION DEPTH, BEDDING AND BACKFILL _ — r: <br /> 11; V.ANCHORING SYSTEMS — — CITY,STATE.ZIP <br /> VI.TESTING TELEPHONE <br /> =!= VII. VENTING: DOUBLE WALL <br /> INSTALLATION COMPLETIONlSUPERVISOR'S SIGNATURE <br /> 3 <br /> VIII. PLASTEEL° SEALING PROCEDURES <br /> The responsible supervisor's signature below represents •_r; <br /> =!G that phases I through VIII were properly completed per the 'h. <br /> INSTALLATION DESCRIPTION <br /> PLASTEEL'a COMPOSIT Installation Instructions: <br /> INSTALLATION SITE .=!= <br /> SIGNATURE DATE <br /> ADDRESS <br /> PRINT NAME tri <br /> Ali II\. <br /> C. STATE.ZIP _ <br /> PLASTEEL" TANK OWNER YOUR PLASTEEL° TANK MANUFACTURER IS: :=!G <br /> , `. <br /> P _ <br /> NAME NAME <br /> :=rte 'I <br /> ADDRESS <br /> ADDRESS <br /> r/ <br /> r� CITY.STATE ZIP <br /> ` CITY,STATE.21P <br /> J ( <br /> GATE TELEPHONE %rte <br /> SIGNATURE <br /> 'i` RETURN COMPLETED FORM TO MANUFACTURER TO ACTIVATE WARRANTY <br /> FORM INST CERT-0792C <br />