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CERTIFICATION OF SUBSTANTIAL HARM DETERMINATION FORM FACILITY NAME: Dameron Hospital FACILITY ADDRESS: 525 W Acacia Street, CA 95203 US ENVIRONMENTAL PROTECTION AGENCY(USEPA) CRITERION 1. Does the non-transportation facility have a total oil storage capacity greater than or equal to 42,000 gallons and transfers oil over water to or from vessels? YES NO X 2. Does the facility have a maximum oil storage capacity greater than or equal to one million (1,000,000) gallons and is the facility without secondary containment for each aboveground storage area sufficiently large to contain the capacity of the largest aboveground storage tank within the storage area? YES NO X 3. Does the facility have a maximum oil storage capacity greater than or equal to one million (1,000,000) gallons and is the facility located at a distance such that a discharge from the facility could cause injury (as defined at 40 CFR 112.2) to fish and wildlife and sensitive environments? (See Attachment C-III for the formulas to determine the distance at which an oil spill could cause injury.) YES NO X 4. Does the facility have a maximum oil storage capacity greater than or equal to one million (1,000,000) gallons and is the facility located at a distance (as calculated using the appropriate formula in Attachment C-III of 40 CFR 112.20 Appendix A, or an alternative formula considered acceptable by the USEPA), such that a discharge from the facility would shut down a public drinking water intake, which is analogous to a public water system as described in 40 CFR 143.2? YES NO X 5. Does the facility have a maximum oil storage capacity greater than or equal to one million (1,000,000) gallons and within the past 5 years, has the facility experienced a reportable spill in an amount greater than or equal to 10,000 gallons? YES NO X US COAST GUARD (USCG) CRITERIA 1. Does the facility transfer oil to marine vessels with a capacity greater than 250 barrels (10,500 gallons)? YES NO X If the answer to each of the above questions is "NO", then this facility is not required to prepare and submit a Facility Response Plan to the USEPA. CERTIFICATION certify, under penalty of law, that I have personally examined and am familiar with the information submitted in this document, and that based on my inquiry of those individuals responsible for obtaining this information, I believe that the submitted information is true, accurate, and complete. Signature: Date: Printed Name: Title: Dameron Hospital Spill Prevention Control and Countermeasure Plan June 12,2020 v