DERR-2025-003348

Publication:WRF-0001
Issue Date: 01-06-15
Supercedes:01-31-11
OPW
FUELING CONTAINMENT SYSTEMS Warranty Registration
COMPLETED BY CONTRACTOR /
FlexWORKS
SY OPW FUELING GONTAINMINT BYSTEMS
TO BE INSTALLER
Contractor
Name: CSESCO INC.
Address: 830 W. NORTH POINTE CIR.
NORTH SALT LAKE UT, 84054
Email: [e-mail]
Fax: [phone]
Phone: [phone]
Training Certification Expiration Date: 2-07-25
Installation Site
Name: B'S BALLARD
Address: 1697 E. HWY 40
BALLARD UTAH 84066
Installation Date: 11-7-24
Distributor: CSESCO INC.
IMPORTANT - The Product Warranty only becomes effective upon completion and return of this form to the Marketing Department of
OPW Retall Fueling. (See reverse side for mailing). Please return this form within 14 days of site installation either by mail, by fax (fax number919-573-9497) or by emall to [e-mail].
TANK SUMPS, TRANSITION SUMPS & MANHOLE COVERS
Yes No Yes No
1. Were all sumps inspected for damage prior to installation?5. If the riser was cut down, was it measured and cut 1/4"
below the inside valley of the corrugate at sump riser?2. Is the site known to have a high water table?
3. How many Tank Fitting Adapters (TFA-4090 or SMF-4E)
were used?
(1)(2)6. Was the cover installed onto the sump riser during backfilling?Π
7. Were the instructions in the product manual followed?D 미
8. Was a hydrostatic test performed on each sump?4. Were all compression rings installed on two piece sumps?
(if applicable)9. Was the sump cleaned of all debris?
1. Were all sumps inspected for damage prior to installation?
2. Were all of the stabilizer bars secure?
3. Were all the provided anchor bolts installed?
DISPENSER SUMPS
Yes No Yes No
4. Was a hydrostatic test performed on each sump?Π
5. Were the instructions in the product manual followed?Π ㅁ
6. Was the sump deaned of all debris?
PIPE & CONDUIT ENTRY SEALS
Yes No Yes No
1. Was the correct size hole saw used on each size entry boot?3. Were all entry boot nuts secure & tightened to 60 in. lbs.?
2. Were all band clamps secure & tightened, not to exceed
30 in. lbs.?
4. Are all pipe & conduit entries less than 15° off center-line?
FLEXIBLE PIPING
1. What size Piping was installed? 3/4"171-1/22 3 4" Pipe date code 24041915
2. What type of flexible piping was installed?
미
3. What type of fittings were installed? Coaxial
UL Approved FlexWorks Single WallUL Approved FlexWorks Double Wall Access Pipe (AXP)
BlueLine Single WallBlueline Double Wall EN14125 Single Wall
Swivel Swivel Bolt-On (SBC)
4. What type of fuel is to be stored?Gasoline Gasoho!
Π Double Wall Swivel (DPC)Barbed Stainless
MethanolEthanol Diesel KeroseneFuel Oit Other DEF
Steel
EN14125 Double Wall
13. Was the primary piping air tested?
5. Was the site contaminated prior to install?Yes No
Yes No Yes No
6. Was all piping inspected for damage prior to & after installation?Π 12. Were all piping connections tightened to the required specification?
7. Were all couplings inspected for damage prior to & after installation?
8. Were all fittings inspected for damage prior to & after installation?
ΠΠ
9. Were only approved backfill materials used around the piping?
10. Were the instructions in the product manual followed?
11. Were crossover supports used at all direct bury piping crossovers?
14. Was the interstitial space of the Double Wall piping air tested?
15. Was Access Pipe (AXP) used?
16. Was the secondary left open to atmosphere after testing?
17. Were all connections/pipe entries/sumps straight & aligned properly?
CONTRACTOR
I hereby certify that the above information is correct, and that I have read the OPW Retail Fueling Warranty enclosed. I have reviewed the respective OPWProduct Manuals and have received training by an OPW preaining by an OPWrepresentative on the proper installation procedures for components of the FlexWorks Piping System.Copy protocol (1) Contractor (1) End User
Date:
- LuKE KELSO
OPW Retail Fueling 3250 Hwy 70 Business West Smithfield, NC Tel: [phone] www.opwglobal.com