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FIED PROGRAM CONSOLIDATED FO <br />TANKS <br />UNDERGROUND STORAGE TANKS - INSTALLATION 882-DIUI WGMG03:138 <br />CERTIFICATE OF COMPLIANCE (one page per tank) <br />of <br />I. FACILITY IDENTIFICATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 <br />Lawrence Livermore National Laboratory — Site 300 <br />ADDRESS (For local use only) 476 <br />Corral Hollow Road <br />FACILITY ID# <br />1 TANK ID # 477 <br />3 9 0 0 0 2 3 1 9 4 5 882-D1U1 (29) <br />II. INSTALLATION <br />(Check all that apply) <br />478 <br />® The installer has been trained and certified by the tank and piping manufacturers. <br />❑ The installation has been inspected and certified by a registered professional engineer having education and experience 479 <br />with underground storage tank installations. <br />480 <br />® The installation has been inspected and approved by the Unified Program Agency. <br />481 <br />® All work listed on the manufacturer's installation checklist has been completed. <br />482 <br />® The installer has been certified or licensed by the Contractors' State License Board. <br />® The underground storage tank, any primary piping, and secondary containment was installed according to applicable 483 <br />voluntary consensus standards and written manufacturer's installation procedures. <br />Description of work being certified: <br />New secondary containment sump was installed on UST 882-D1U1. <br />New UL approved primary underground piping was installed on UST 882-D1U1. <br />New UL approved secondary underground piping was installed on UST 882-D1U1. <br />New spill bucket was installed on UST 882-D1U1. <br />III. TANK OWNER/AGENT SIGNATURE <br />I certify that the information provided herein i§ true and accurate to the best of my knowledge <br />SIG7ARE OF OXANK DATE 484 <br />9/23/2003 <br />NkM OF TANK OWNER/AlKE91"(printj 485 TITLE OF TANK OWNER/AGENT 486 <br />William G. Hoppes Group Leader, Water Guidance and Monitoring Group, <br />Environmental Protection Department <br />UPCF (1/99 revised) 177 Formerly SWRCB Form C <br />