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0 San <br />Joaquin County <br />Owners Statement of Designated UST Operator(s) and <br />Understanding of and Compliance with UST Requirements <br />Facility Name: Lawrence Livermore National Laboratory Site 300 (see Building List below) <br />Facility Site Address: Corral Hollow Road near 1-580 <br />City: Tracy CA <br />Mailing Address: PO Box 808 L-633 Livermore CA 94551 <br />Facility ID#: FA0003934 <br />Building List UST(s) <br />Building 879 879-D1U1, 879-G3U1 <br />Building 882 882-D1 U1 <br />The individuals named below are Designated UST Operators for each of the permitted USTs listed above. <br />Designated UST Operator(s) for this Facility <br />Name <br />ICC Certification <br />Number <br />Expiration <br />Date <br />Phone Number <br />Richard Joseph McAlice <br />Pending <br />12/6/2006 <br />925 422-0169 <br />Beverlee Morales <br />5241035 -UC <br />8/31/2006 <br />925 422-7481 <br />Greg Wright <br />Pending <br />11/17/2006 <br />925 422-0169 <br />NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS INFORMATION <br />WITHIN 30 DAYS OF THE CHANGE. <br />I certify that, for the facility indicated at the top of this page, the individual(s) listed above will <br />serve as Designated UST Operator(s). They will conduct and document monthly facility <br />inspections and annual facility employee training, in accordance with California Code of <br />Regulations, Title 23, section 2715 (c) - (f). <br />Furthermore, I understand and am in compliance with the requirements (statutes, <br />regulations, and local ordinances) applicable to underground storage tanks. <br />C. Susi Jackson <br />Name of Tank OwnAgent <br />Signature of Tank Ow'her.6r Owner's Agent <br />Owners Statement - DO Form <br />(925) 423-6577 <br />Phone Number <br />Date <br />