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AMENDMENT OF SPCC PLAN BY THE OWNER OR OPERATOR-40 CFR 112.5 <br /> 112.5(a) Has there been a change at the facility that materially affects the potential for a discharge [7]Yes ❑No <br /> described in §112.1(b)? <br /> If YES . Was the Plan amended within six months of the change? ❑Yes ❑ No <br /> • Were amendments implemented within six months of any Plan amendment? ❑Yes ❑ No <br /> 112.5(b) Review and evaluation of the Plan completed at least once every 5 years? ❑ Yes No❑NA <br /> Following Plan review,was Plan amended within six months to include more effective ❑ Yes❑I No DNA <br /> prevention and control technology that has been field-proven to significantly reduce the <br /> likelihood of a discharge described in §112.1(b)? <br /> Amendments implemented within six months of any Plan amendment? ❑ Yes❑No❑NA <br /> Five year Plan review and evaluation documented? ❑ Yes❑No DNA <br /> 112.5(c) Professional Engineer certification of any technical Plan amendments in accordance with all ❑ Yes ❑NoE]NA <br /> applicable requirements of§112.3(d)[Except for self-certified Plans] <br /> Name: License No.: [State: Date of certification: <br /> Reason for amendment: <br /> TIER I QUALIFIED FACILITY PLAN REQUIREMENTS—40 CFR 112.6(a) <br /> 112.6(a)(1) Plan Certification: Plan prepared to comply with the requirements of§112.6(a)(3)using the ❑ Yes❑No❑NA <br /> Appendix G template � <br /> (i) He or she is familiar with the requirements of 40 CFR part 112 ❑ Yes❑No!.J NA <br /> (ii) He or she has visited and examined the facility6 ❑ Yes❑No❑NA <br /> (iii) The Plan has been prepared in accordance with accepted and sound industry practices and ❑ Yes ❑No ❑NA <br /> standards <br /> (iv) Procedures for required inspections and testing have been established ❑ Yes ❑No❑NA <br /> (v) He or she will fully implement the Plan ❑ Yes ❑No NA <br /> (vi) The facility meets the qualification criteria in §112.3(g)(1) ❑ Yes ❑No❑NA <br /> (vii) The Plan does not deviate from any requirements as allowed by§§112.7(a)(2)and 112.7(d), <br /> or include measures pursuant to§112.9(c)(6)for produced water containers and any ❑ Yes❑No NA <br /> associated piping <br /> (viii) The Plan and individual(s)responsible for implementing the Plan have the full approval of <br /> management and the facility owner or operator has committed the necessary resources to ❑ Yes❑No❑NA <br /> fully implement the Plan. <br /> 112.6(a)(2) Technical Amendments: The owner/operator self-certified the Plan's technical amendments <br /> for a change in facility design, construction, operation, or maintenance that affected potential ❑ Yes❑No NA <br /> for a§112.1(b)discharge <br /> If YES Certification of technical amendments is in accordance with the self-certification ❑ Yes ❑No Q NA <br /> provisions of§112.6(a)(1). <br /> An individual oil storage container capacity exceeds 5,000 U.S. gallons or the aggregate <br /> aboveground oil storage capacity increased to more than 10,000 U.S. gallons as a result of ❑ Yes❑No ❑NA <br /> the change <br /> If YES The facility no longer meets the Tier/qualifying • because an individualoil storage container <br /> capacity -• III U.S. gallons or aboveground storage capacity exceeds10,000 U.S. gallons <br /> The following has been or will be completed within six months following the amendment: <br /> Plan prepared and implemented in accordance with the requirements for a Tier II ❑ Yes[7)No E]NA <br /> (i) Qualified Facility(§112.6(b))if the facility meets the eligibility criteria OR <br /> (ii) • Plan prepared and implemented in accordance with the general Plan requirements in <br /> §112.7 and applicable requirements in subparts B and C and certified by a PE as ❑ Yes❑I No Q NA <br /> required under§112.3(d) <br /> 6 Note that only the person certifying the Plan can make the site visit <br /> Tier I Qualified Facilities Page 5 of 8 June 2014 <br />