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CERTIF 'JNIF.'IED PROGRAM AGENCY (r k).., <br />SPILL PREVENTION, _.-JNTROL AND COUNTERMEASL _ — ,,SPCC) PLAN <br />STATUS/REFERRALEORM <br />Mail a copy of the completed form to: <br />California Regional Water Quality Control Board <br />Attn: G 00 d t o o LaIJP - <br />Sar CA J5&;t7- <br />Date: D3 l 3-7 1 (�),OOQ <br />CUPA Inspector: <br />Address: S� aA/1 CUAILA( — E � <br />E �U21�eA'VQ A16 3 -' Fl Z r <br />04 Q5a�� <br />The following facility is storing "petroleum" in a single storage tank greater than 660 gallons or in <br />multiple storage tanks with a cumulative storage capacity greater than 1,320 gallons. "Petroleum" <br />means crude oil, or any fraction thereof, which is liquid at 60 degrees Fahrenheit temperature and 14.7 <br />pounds per square inch absolute pressure. This includes petroleum based substances comprised of a <br />complex blend of hydrocarbons, such as gasoline, diesel, jet fuels, residual fuel oils, lubricants, some <br />petroleum solvents, and used oils. Ap example of a substance that is not "petroleum" is liquid propane <br />gas (LPG). Note: The backside of this form identifies storage tanks and facilities exempt frau: the state <br />Aboveground Petroleum Storage Act SPCC requirement. <br />Facility Name: <br />Facility Address: A46 Iy 111n_b* 0K1 <br />Contact: Maze Phone: ( oZ(D-01 ) a 94-7 3 <br />The Facility is in compliance with H&SC Section 25270.5(c), the preparation of an SPCC plan. <br />A complete copy of the facility's SPCC plan, certified by a Registered Professional Engineer, is <br />❑ <br />maintained at the facility, which is normally attended at least 8 hours per day. If the facility is <br />not attended at least 8 hours per day, the SPCC plan is maintained at the nearest field office. <br />The facility is not in compliance with H&SC Section 25270.5(c). <br />This form constitutes a referral to the Regional Board for correction of the followin.Z violation. <br />MThe facility does not have a certified SPCC plan in place. <br />The owner or operator was unaware of the Aboveground Petroleum Storage Act. A copy of the <br />State Nater Resources Control Board, Aboveground Tank Program brochure was provided to <br />the owner or operator. <br />cc: Carol Julian <br />State Water Resources Control Board <br />Division of Clean Water Programs <br />1210 oD P.O. Box 944212 <br />Sacramento, CA 94244-2120 SWRCB, CWP Form AGT-1 (06/28/99) <br />