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O <br /> N <br /> M <br /> Plan <br /> O I _.__--- d Facility Sp" operator of a C <br /> - Tier 1 pualifio the ownet d0 CFR part i 12:' O <br /> nes hY <br /> wt,en completed ares th reViremenis o Or for a C <br /> r — Per AaY. O <br /> O f r the la) T es at a facility <br /> t This temp nded at least tour hours p Y <br /> . r..K.V„1 ale._svlulos the SrC�.Pian O late addresses o efatlonat Chang <br /> t the raGihty is normally atte <br /> t.V K3",y cmeria rn 6t 12.31411 ) uuements <br /> "h C,at.win aCd nearest field office.When making P ; y-- <br /> 5!v a fun a cc Tpkte�Y,r.y or 1he plan.9 the facility follow state and local req <br /> at the ,r,tor should plate. O <br /> h �fou!hOurS Per daY pevnB sloe ° a5 apPro <br /> z 1}attvndetrt3 fewert a uirements.the fess oval assistance, y, <br /> r a•e+.�caLssarV to imply with the rue req t and obtain Pro <br /> O <br /> pi,m,itog des+gll and canstroctoni an0 <br /> QFacility DescriptiOnry �_----"— <br /> Fary;4yName ZIP <br /> � rc.el-� <br /> Ro <br /> O Faoi,r;Addnass � State <br /> IC 7-e Al <br /> city r�C --.__- Tel Number <br /> V County �(uw"i <br /> n Owrntw !��, <br /> or Operator Name. ie e _26 <br /> vJ_ Owrer;,Operator Address �I--� /�ln•.`l _--_ ZIP _ <br /> .� State _= <br /> City CountY. _------ <br /> Cu �- Tel.Number 1r� <br /> O � rti ✓�' � ,�---- <br /> + Self-Certification Statoment(§112.6(a)(1)) late to comply <br /> Thce owner or operator of a facility certifies that each of the followdng is true in order to utilize this temP <br /> v znn the-SPCC requirements <br /> (n iC-M%• �{�,t���r�� certify that the following is accurate: <br /> I I am familiar with the appf cable requirements of 40 CFR part 112. <br /> 2 1 have visited and examined the facility, <br /> 3 This Plan was prepared,n accordance with accepted and sound industry practices and standards, CL <br /> I <br /> 0 4 Procedures for required inspections and testing have been established in accordance with indust U <br /> r <br /> m and testing standards or recommended practices, U <br /> 5 t WD fully impfement the Plan. -r <br /> 6 This facility meets the following qualification criteria(under§112.3(g)(1)):S ~ �.,z <br /> a The aggregate aboveground oil storage capacity of the facility is f$�D U.S.gallons or less and', <br /> b The facility has had no single discharge as described In§1 12.1(b)exceeding 1,000 U.S.gallons ar <br /> Lf) t>,vo discharges as described in§112,1(b)each exceeding 42 U.S gallons within any twelve month p <br /> IN <br /> in the three years prior to the SPCC Plan self-certification date,or since becoming subject to 40 CFR., <br /> 112 if the fa-tt;ty has been in operation for less than three:•years(not including oil discharges as descnbe <br /> in§112 tib)that are the result of natural disasters,acts of war,or terrorism);and <br /> C) c There+s n,,ir:divtdual oil storage container at the facility with an aboveground capacity greater than , <br /> J U.S gallons _. ,- <br /> J 7 Tn:, any requirement of 40 CFR part 112.as allowed by§112,7(a)(2)(environmental <br /> i,r,,- iblllty of secondary containment)or include any measures pursuant to <br /> C rr, ;npiping; <br /> and any associated pi <br /> • i g; <br /> t t ,t;le for Implementing this Plan have the full approval of management and I ., <br /> to fully Implement this Plan <br /> O <br /> C <br /> (t3 _ <br /> J <br /> O <br /> L Fa,. <br /> e1 Quelifed Fi►aiiiH <br /> ' ,SPCC Plan` <br /> r <br />