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er.1 L-doc 3 9810 ac� This template constitutes the SPCC Plan for the facility,when completed and signed by the owner or operator of a facility that meets the applicability criteria in§112.3(g)(1).This template addresses the requirements of 40 CFR part 112. Maintain a complete copy of the Plan at the facility if the facility is normally attended at least four hours per day, or for a facility attended fewer than four hours per day, at the nearest field office.When making operational changes at a facility that are necessary to comply with the rule requirements, the owner/operator should follow state and local requirements__ (such as for permitting, design and construction)and obtain professional assistance, as appropriate. Facility Description Facility Name .1 o Facility Addresses City State County �Zoll Tel. Number - „;.D Owner or Operator Name Owner or Operator Address City State ZIP County Tel. Number ( ) - 1. Self-Certification Statement(§112. (a)(1)) The owner or operator of a facility certifies that each of the following is true in order to utilize this template to comply with the SPCC requirements: I certify that the following is accurate: I. I m familiar ith a applicable requirements of part 112; . I have visited and examined the facility. . This Plan was prepared in accordance with accepted and sound industry practices and standards; 4. Procedures for required inspections and testing have been established in accordance with industry inspection and testing standards or recommended practices; 5. 1 will fully implement the Plan; 6. This facility meets the following qualification criteria(under§112.3(g)(1)): a. The aggregate aboveground oil storage capacity of the facility is 10,000 U.S. gallons or less; and b. The facility has had no single discharge as described in§112.1(b)exceeding 1,000 U.S. gallons and no two discharges as described in 112.1(b)each exceeding 42 U.S. gallons within any twelve month period in the three years prior to the SPCC Plan self-certification date, or since becoming subject to 40 CFR part 112 if the facility has been in operation for less than three years(not including oil discharges as described in§112.1(b)that are the result of natural disasters, acts of war, or terrorism); and c. There is no individual oil storage container at the facility with an aboveground capacity greater than 5,000 U.S. gallons. 7. This Plan does not deviate from any requirement of 40 CFR part 112 as allowed by§112.7(a)(2)(environmental equivalence)and§112.7(d) (impracticability of secondary containment)or include any measures pursuant to 112.9(c)(6)for produced water containers and any associated piping; 8. This Plan and individual(s) responsible for implementing this Plan have the full approval of management and I have committed the necessary resources to fully implement this Plan. Facility Name: _ % Pae 1 9 Tier I Qualified Facility SPCC Pian