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EDSTgTFs RECEIVED o� yIr U.S. ENVIRONMENTAL PROTECTION AGENCY NOV 04 2013 Z��yrq�PRDtTIER I QUALIFIED FACILITY SPCC PLAN TEMPLATE ENVIRONMENTAL Instructions to Complete this Template HEALTH DEPARTMENT This template is intended to help the owner or operator of a Tier I qualified facility develop a self-certified Spill Prevention, Control, and Countermeasure (SPCC) Plan. To use this template, your facility must meet all of the applicability criteria of a Tier I qualified facility listed under§112.3(g)(1) of the SPCC rule. This template provides every SPCC rule requirement necessary for a Tier I qualified facility, which you must address and implement. You may use this template to comply with the SPCC regulation or use it as a model and modify it as necessary to meet your facility-specific needs. If you modify the template, your Plan must include a section cross-referencing the location of each applicable requirement of the SPCC rule and you must ensure that your Plan is an equivalent Plan that meets all applicable rule requirements of 40 CFR 112.6(a)(3). You may complete this template either electronically or by hand on a printed copy. This document is a reformatted version of the template found in Appendix G of 40 CFR part 112.a No substantive changes have been made. Please note that a "Not Applicable" ("N/A") column has been added to both Table G-10 (General Rule Requirements for Onshore Facilities) and Table G-11 (General Rule Requirements for Onshore Oil Production Facilities). The "N/A" column should help you complete your self- certification when a required rule element does not apply to your facility. Use of the "N/A"column is optional and is not required by rule. All Tier I qualified facility self-certifiers must complete Sections I, II, and III. Additionally, the owner or operator of an: • Onshore facility(excluding production) must complete Section A. • Onshore oil production facility(excluding drilling and workover facilities) must complete Section B. • Onshore oil drilling and workover facility must complete Section C. Complete and include with your Plan the appropriate attachments. You should consider printing copies of the attachments for use in implementing the SPCC Plan (e.g. Attachment 3.1 - Inspection Log & Schedule; Attachment 4 - Discharge Notification Form). To complete the template, check the box next to the requirement to indicate that it has been adequately addressed. Either write "N/A" in the column or check the box under the"N/A" column to indicate those requirements that are not applicable to the facility. Where a section requires a description or listing, write in the spaces provided (or attach additional descriptions if more space is needed). Below is a key for the colors used in the section headers: Sections I, II,and III: Required for all Tier I qualified facilities Section A: Onshore facilities(excluding production) Section B: Onshore oil production facilities(excluding drilling and workover facilities) Section C: Onshore oil drilling and workover facilities Attachments: 1 -Five Year Review and Technical Amendment Logs 2-Oil Spill Contingency Plan and Checklist 3- Inspections, Dike Drainage and Personnel Training Logs 4-Discharge Notification Form After you have completed all appropriate sections, certify and date your Plan, and then implement it by the compliance date. If your facility was in operation before August 16, 2002, and you do not already have a Plan, then implement this template immediately. Conduct inspections and tests in accordance with the written procedures that you have developed for your facility. You must keep with the SPCC Plan a record of these inspections and tests, signed by the appropriate supervisor or inspector, for a period of three years. Do not forget to periodically review your Plan (at least once every five years) or to update it when you make changes to your facility. You must prepare amendments within six months of the facility change, and implement them as soon as possible, but not later than six months following preparation of any amendment. In the event that your facility releases oil to navigable waters or adjoining shorelines, immediately call the National Response Center(NRC) at 1-800-424-8802. The NRC is the federal government's centralized reporting center, which is staffed 24 hours per day by U.S. Coast Guard personnel. a Please note that the use of this template is not mandatory for a Tier I qualified facility. You may also meet the SPCC Plan requirement by preparing a satisfactory Tier II qualified facility Plan,preparing a satisfactory Plan that is certified by a Professional Engineer,or by developing an equivalent Plan for a Tier I qualified facility. Further information on the requirements of these methods can be found in 40 CFR part 112.6(a)(1). If you use any of these alternative methods you must include a cross reference in your Plan that shows how the equivalent Plan meets all applicable 40 CFR part 112 requirements.