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w CERTIF U ,IED PROGRAM AGENCY,( �) <br /> SPILL-PREVENTION:CONTROL AND COUNTERIVIBASU r (SPCC)PLAN <br /> »' _ STATUS/REFERRAL FORM <br /> Mail a copy of the completed form to: CUPA Inspector: ( <br /> California Regional Water Quality Control Board Address: SO C( <br /> Attn: C-i Ax cN 0\c � �I <� Z O Z <br /> , CA I <br /> Phone: ( <br /> Date: <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 /> Facility Name: IJL� ot, U J �AX IkAA <br /> Facility Address: <br /> Contact: Phone: <br /> The Facility is in compliance with H&SC Section 25270.5(c), the preparation of an SPCC plait. <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 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 Reizional Board for correction: of the following violation. <br /> The 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 /> P.O.Box 944212 <br /> Sacramento,CA 94244-2120 SWRCB,CWP Form AGT-1 (06/28/99) <br /> 1 <br />