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CERTIFIED UNIFIED PROGRAM AGENCY (COPA) SPILL PREVENTION CONTROL AND COUNTERMEASURE (SPCC) PLAN STATUS REFERRAL FORM Mail Copy of the completed form: COPA Inspector: Steven C. Shih California Regional Water Quality Control Address: San Joaquin County, Environmental Health i Board Department Attn: Wendy Cohen 304 E.Weber Avenue, 3d Floor Stockton, CA 95202-2708 LLLCALJ Phone: (209)468-9850 Date: The following facility is storing "petroleum" in a single storage tank greater than 1320 gallons or in multiple storage tanks with a cumulative storage capacity greater than 1,320 gallons. "Petroleum" means crude oil, or any fraction thereof, which is liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure. This includes petroleum based substances comprised of a complex blend of hydrocarbons, such as gasoline, diesel,jet fuels, residual fuel oils, lubricants, some petroleum solvents, and used oils. An example of a substance that is not"petroleum" is liquid propane gas(LPG). Note: The bac9side of this form identifies storage tanks and facilities exempt from the state Aboveground Petroleum Storage Act SPCC requirement Facility Name: Orchard Supply Hardware Mailing Name: Same Facility Contact: Ann Doyle Mailing Contact: Same Contact's Phone Contact's Number: (209)533-3115 Phone Number: Same FacilityAddress Mailing Address (street address) 2650 Macarthur Drive (street address) Same City Tracy City Same State/Zip 95376 State/Zip Same PLEASE SELECT ONE OF THE FOLLOWING: The facility is not in compliance with H&SC Section 25270.5(c); a SPCC Plan has not been prepared. ❑ This form constitute a referral to the Regional Board for correction of the following violation. The facility does not have a certified SPCC Plan in place. --OR-- /The facility is in compliance with H&SC Section 25270.5(c), the preparation of a SPCC Plan. A complete copy of the facility's SPCC Plan, certified by a Registered Professional Engineer, is maintained at the facility, which is normally attended at least 8 hours per day. If the facility is not attended at least 8 hours per day, the SPCC Plan is maintained at the nearest field office. ❑ Please check here if a copy of the State Water Resources Control,Aboveground Petroleum Storage Tank Program brochure was provided to the owner or operator. Additional information regarding this program can be found at http://www.swrcb.ca.gov(click on "Tanks/Landfills") SWRCB, CWP Form ACT-1 (06/28/99)