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Tank Installation Checklist <br /> For Fiberglass Underground Tanks O <br /> � O <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 SC.,cv ���!`� Date of Installation <br /> (� q-✓e CY1 Te�e' C.4 - <br /> Site Address A <br /> � � ��'es � t.t.1 et City State Zip j <br /> Installing Contractor <br /> Company Street City State Zip <br /> IN <br /> Competed N/A j <br /> i <br /> 1. Installation backfill material meets CSI specification(sieve analysis is attached). <br /> Indicate which material you used: 1W 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 /> — <br /> 3. Excavation and tank clearance meet requirements of Section 6. <br /> 4. Geotextile used to line excavation: X Yes ❑ No <br /> i <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: j <br /> i <br /> Indicate which method you used Deadmen r <br /> 4 <br /> ❑ Anchor Pad <br /> M ❑ No mechanical anchoring L� i <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. I <br /> 1 <br /> 10. Tanks ballasted according to Section 10. r <br /> 11. Tank burial depth complies with the requirements of Section 8. <br /> 12. Piping and bottom sump clearances according to Section 13. f <br /> 13. All piping connections are flexible connections according to Section 13. <br /> O <br /> Installation was in accordance with Tank Installation Instructions(INST.6001). <br /> i <br /> GQf1Jl, r%4 <br /> Owner RL114esentative(P' Name) Date Contractor Representative(Print Name) Date S <br /> Owner Representative(Signature) Date 30 Contractor Representative(Signature) Date <br />