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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 greaterthan 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 Cd1l for the formulas to determine the distance at which an oil spill could cause I njury . ) 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 ( 101500 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 I 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 b lieve at the submitted information is true , accurate , and complete. Signature : Date : Printed Name : / V ink �/'�a4, Title : Dameron Hospital Spill Prevention Control and Countermeasure Plan June 29 , 2020 v