Ex-3.319

Exhibit 3.319

05-28-03 07:03 From-

State of Delaware

SECRETARY OF STATE

Division of Corporations

Delivered 09:09 AM 05/28/2003

FILED 09:09 AM 05/28/2003

SRV 030345712 — 2964867 FILE

SECOND AMENDED AND RESTATED
CERTIFICATE OF FORMATION
OF

TRI-SHELL 26 LLC

Linder Section 18-208 of the
Delaware Limited Liability Company Act

This Second Amended and Restated Certificate of Formation of Tri-Shell 26 LLC (the “Company”) has been duly executed and is being filed by the undersigned, as an authorized person, in accordance with the provisions of Section 18-208 of the Delaware Limited Liability Company Act, to again amend and restate the Amended and Restated Certificate of Formation (the “Certificate of Formation”) of the Company, which was filed on October 2, 2002 with the Secretary of State of Delaware.

1. The original name of the Company was Huntington Imaging, LLC and its Original Certificate of Formation was filed November 9, 1998.

2. The name of the Company was subsequently changed to Tri-Shell 26 LLC pursuant to the Amended and Restated Certificate of Formation filed October 2, 2002.

3. The Certificate of Formation is hereby again amended and restated in its entirety to read as follows:

“FIRST: The name of the Company is Triad of Alabama, LLC

SECOND: The address of the registered office of the Company in the State of Delaware is 2711 Centerville Road, Suite 400, Wilmington, Delaware 19808, County of New Castle

THIRD: The name and address of the registered agent for service of process on the Company in the State of Delaware is Corporation Service Company, 2711 Centerville Road, Suite 400, Wilmington, Delaware 19808, County of New Castle.”