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. CERTff — JNIFIED PROGRAM AGENCY>(rT�' �).,, <br />w 7 <br />SPILL PREVENTIG�. CONTROL AND COUNT`ERMEASL _ ,3PCC) PLAN <br />STATUS/REFERRAL FORM <br />form to: CUPA Inspector: '51, <br />Mail a copy of the completed fo �[ <br />California R'/egional Water Control Board Address: <br />Attn:C AY-r,DI4 :-V Ql tL� <br />0 ' <br />of 16 ' , CA9;g 3 <br />Phone: (,2 ) <br />Date: I / 1 / 0 L <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. All 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 />Ahnuvvrnund Petroleum Storage Act SPCC requirement. <br />Facility Name: tWY14 1 <br />Facility Address: <br />N� <br />Contact: Phone: <br />The Facility is in compliance with H&SCSection 25270.5(c), the preparation of an SPCCPlan. <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 following violation. <br />nThe facility does not have a certified SPCC plan in place. <br />�State <br />or operator was unaware of the Aboveground Petroleum Storage Act. A copy of the <br />Resources Control Board, Aboveground Tank Program brochure was provided to <br />the owner or operator. <br />\ cc: Carol Julian <br />v State Water Resources Control Board <br />I�UO Division of Clean Water Programs <br />P.O. Box 944212 <br />Sacramento, CA 94244-2120 SWRCB, CWP Form AGT-1 (06/28/99) <br />