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CERTIFIED ,PIED PROGRAM AGENCY (CUPA� <br />.SPILL: PREVENTION Ci,�yTROL AND COUNTERMEASURE ,C) PLAN <br />Mail a copy of the completed form to: <br />CalifornJ Re tonal Water r,Qualih' Control Board <br />Attn: <br />616 <br />cSGtC� ,CA <br />Date: -( i / q l 26OD <br />CUPA Inspector: AI l cn✓� ��d�`� ��� <br />Address: <br />2�r ►. �. VI�Q.Ia-2X A'U•e ��l�u/id baa 1�- <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 from the state <br />Aboveground Petroleum Storage Act SPCC requirement. _ <br />C <br />Facility Name: <br />Facility Address: <br />hone: /51 <br />Contact: �JidP(� ) <br />C(.�2, - �% <br />H <br />the <br />am <br />The Facility is tui com uan�e �•• - - <br />A complete copy of the facility's SPCC plan, certified by a Registered Professional Engineer, is <br />maintained at the facility, which is normally attended at least 8 o at the nearest field urs er day. If the facility <br />ice.ts <br />not attendeo at least 8 hours per day, the SPCC plan is <br />main <br />The facility is not in compliance with H&SC Section 252 ji 5270 toll. <br />This form consrirures �C •� - - <br />The facility does not have a certified SPCC plan in place. <br />rage Act. A copy of <br />Th:owner or operator was unawareard fAboveground Tank Program bthe Aboveground Petroleum troochure was provided to <br />the <br />StaWater Resources Con <br />thewner or operator. <br />cc: Carol Julian <br />State Water Resources Control Board <br />Division of Clean Water Programs <br />P.O. Box 944212 SWRCB,CWP Form AGT-1 (06/29/99) <br />Sacramento, CA 94244-2120 <br />