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ATTACHMENT D: TIER II QUALIFIED FACILITY CHECKLIST ❑ NA TIER II QUALIFIED FACILITY PLAN REQUIREMENTS—40 CFR 112.6(b) 112.6(b)(1) Plan Certification: Owner/operator certified in the Plan that: ❑Yes ❑No (i) He or she is familiar with the requirements of 40 CFR part 112 ❑Yes ❑No DNA (ii) He or she has visited and examined the facility's ❑Yes [:]No DNA (iii) The Plan has been prepared in accordance with accepted and sound industry practices and ❑Yes ❑No [:INA standards and with the requirements of this part (iv) Procedures for required inspections and testing have been established ❑Yes [:]No ❑NA (v) He or she will fully implement the Plan ❑Yes ❑No ❑NA (vi) The facility meets the qualification criteria set forth under§112.3(g)(2) ❑Yes ❑No DNA (vii) The Plan does not deviate from any requirements as allowed by§§112,7(a)(2)and 112.7(d), ❑Yes [:]No [:INA except as described under§112.6(b)(3)(i)or(ii) (viii) The Plan and individual(s)responsible for implementing the Plan have the full approval of ❑Yes ❑No [:INA management and the facility owner or operator has committed the necessary resources to fully implement the Plan. 112.6(b)(2) Technical Amendments: The owner/operator self-certified the Plan's technical amendments ❑Yes ❑No ❑NA for a change in facility design, construction, operation, or maintenance that affected potential for a§112.1(b)discharge If YES • Certification of technical amendments is in accordance with the self-certification El Yes ❑No DNA provisions of 112.6 b 1 . (i) A PE certified a portion of the Plan (i.e., Pian is informally referred to as a hybrid Plan) ❑Yes [:]No []NA If YES The PE also certified technical amendments that affect the PE certified portion of the ❑Yes ❑No DNA Plan as required under§112.6 b 4 ii (ii) The aggregate aboveground oil storage capacity increased to more than 10,000 U.S. gallons ❑Yes No ❑NA as a result of the change If YES The facility no longer meets the Tier I/qualifying r because it exceeds f 01I U.S. gallons in aggregate rr es • . storage capacity. The owner/operator prepared and implemented a Plan within 6 months following the change ❑Yes [:]No DNA and had it certified by a PE under§112.3(d) 112.6(b)(3) Plan Deviations: Does the Plan include environmentally equivalent alternative methods or [:1 Yes ❑No ❑NA impracticability determinations for secondary containment? If YES Identify the alternatives in the hybrid Plan: Environmental equivalent alternative method(s)allowed under§1 12.7(a)(2); -]Yes —1 No DNA • Impracticability determination under§1 12.7(d) ❑Yes ❑No DNA 112.6(b)(4) . For each environmentally equivalent measure, the Plan is accompanied by a written ❑Yes [—]No [:]NA statement by the PE that describes:the reason for nonconformance, the alternative measure, and how it offers equivalent environmental protection in accordance with §112.7(a)(2); For each secondary containment impracticability determination, the Plan explains the ❑Yes [:]No ❑NA reason for the impracticability determination and provides the alternative measures to secondary containment required in §112.7(d) AND (i) PE certifies in the Plan that: (A) He/she is familiar with the requirements of 40 CFR Part 112 ❑Yes ❑No DNA (B) He/she or a representative agent has visited and examined the facility ❑Yes ❑No DNA (C) The alternative method of environmental equivalence in accordance with §112.7(a)(2)or the ❑Yes ❑No DNA determination of impracticability and alternative measures in accordance with §112.7(d) is consistent with good engineering practice, including consideration of applicable industry standards, and with the requirements of 40 CFR Part 112. Comments: "Note that only the person certifying the Plan can make the site visit Onshore Facilities(Excluding Oil Production) Page D-1 of June 2014