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Environmental Construction Inc. PEI Thornton , P.O. Boz 360833 Milpitas, CA 95036-0833 Phone(408)946-1015•(209)834-0792•Fax(209)834-0795 Monitoring System Certification A. General Information Facility Name: Lawrence Livermore National Laboratory Site 300 Bldg.No. 882 Site Address: Corral Hollow Road City: Tracy Site Address: Facility Contact Person: Willie Smith Contact Phone No: (925)423-0414 Make/Model of Monitoring System: USD LA-02 Date of Testing/Service: 9-14-2006 B. Inventory of Equipment Tested/Certified Check thea ro riate boxes to indicatesEEjEE Eq!!pmnent ins serviced: Tank ID: 882-DIU1 DIESEL Tank ID: In-Tank Gauging Probe. Model: ❑In-Tank Gauging Probe. Model: ■Annular Space or Vault Sensor. Model: LALS-1 ❑Annular Space or Vault Sensor. Model: ■Piping Sum /Trench Sensor(s). Model: LALS-1 ❑Piping Sum /Trench Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ❑Mechanical Line Leak Detector. Model: ❑Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: U Tank Overfill/Hi -Level Sensor. Model: ❑Tank Overfill/Hi -Level Sensor. I Model: ❑Other(specify equipment type and model in Section E on Page ❑Other(specify equipment type and model in Section E on Page 2) 2 Tank ID: Tank ID: ❑In-Tank Gauging Probe. Model: ❑In-Tank Gauging Probe. Model: ❑Annular Space or Vault Sensor. Model: ❑Annular Space or Vault Sensor. Model: ❑Piping Sum /Trench Sensor(s). Model: ❑Piping Sum /Trench Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ❑Mechanical Line Leak Detector. Model: ❑Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Tank Overfill/High-Level Sensor. Model: ❑Tank Overfill/l-figh4.evel Sensor. Model: ❑Other(specify equipment type and model in Section E on Page ❑Other(specify equipment type and model in Section E on Page 2) 2 Dis enser ID: NO DISPENSER Dispenser ID: ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑Shear Valve(s). ❑Shear Valve(s). ❑Dispenser Containment Floats and Chain(s). ❑Dispenser Containment Floats and Chain(s). Dispenser ID: Dis enser ID: ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Shear Valve(s). ❑Dispenser Containment Float(s)and Chain(s). ❑Dispenser Containment Float(s) and Chain(s). *If the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at the facility. C. Certification -I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report; check all that apply): ❑ System set-up ❑Alarm history report Technician Name: Brian Thornton Signature: �-- Certification No. 0348 License No. 724513 ICC No. 5289253-UT Testing Company Name: Thornton Environmental Construction, Inc. Phone No. 408 946-1015 Page 1 of 3 03/01