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AFFILIATE Thornton Environmental Construction Inc. �(EUMEQUIPMEHTINS~ P.O. Box 360833 Milpitas, CA 95036-0833 Phone (408) 946-1015 9 (209) 834-0792 • Fera (209) 834-0795 Monitoring System Certification A. General Information Facility Name: Lawrence Livermore National Laboratory Site 300 Model: Bld . No. 882 Site Address: Corral Hollow Road City: Trac Zip: 95376 Facifity Contact Person: Willie Smith Contact Phone No: (925) 423-0414 Make/Model of Monitoring System: USD LA -02 Date of Testing / Service: 9-8-2008 B. Inventory of Equipment Tested/Certified Check the appropHate boxes to indirrte s ecific a ui ment ins ected/serdced: Tank ID: 882-DIU1 DIESEL 11 Tank ID: ❑ In -Tani: Gauging Probe. Model: ■ Annular Space or Vault Sensor. Model: LALS-1 ■ Piping Sum / Trench Sensor s). Model: LALS-1 ❑ Fill Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Lune Leak Detector. Model: ❑ Tank Overfill / ffi -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E on Page 2) ❑ In -Tank Gauging Probe. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sum / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑ Mechanical Lune Leak Detector. Model: ❑ Electronic Lune Leak Detector. Model: ❑ Tank Overfill / Hi -Level Sensor. I Model: ❑ Other (specify equipment type and model in Section E on Page 2 Tank ID: Tank ID: pl ❑ hi -Tank Gauging Probe. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Piping SLunp / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E on Page 2 ❑ In -Tank Gauging Probe. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sump I Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E on Page 2) Dis enser ID: NO DISPENSER Dis enser ID: ❑ Dispenser Containment Sensor(s). Madel: _ ❑ Dispenser Contauunent Sensor(s). Model: ❑ Shear Valve(s). ❑ Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). ❑ Dispenser Containment Float(s) and Chain(s). Dis enser ID: Dis enser 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). *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 ThorntonSi ature: Certification No. 08-0472 1 License No. 724513 ICC No. 5302825 -UT Testing Company Name: Thornton Environmental Construction, Inc. i Phone No. 209 834-0792 Page 1 of 3 03101