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. CERT_ D..UNIFIED:PROGRAM AGENCY TTPA).: ; <br />SPILL PREVENTIONCONTROL AND. COUNTERMEAS cZE (SPCC) PLAN <br />} STATUS%REFERRAL FORM .. <br />Nlail a copy of the completed form to: <br />California Regional Water Quality Control Board <br />Attn: C', , mold, Inc) IQ t-,,G�CA <br />Date: u ! 2-2, ! 0 <br />CUPAInspector: A <br />Address:r pc <br />3lJ'�l � ��"/� <br />J occ C� u w� aro <br />�� un ,CA gS�oz <br />Phone:( <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: r' <br />1J - <br />Facility Address: 1-10q CC <br />S�. I Esc0-1 CP 0[S7:6? -0 <br />Contact: i�'� ` � -- Phone: ( Wq <br />The Facility is in com liance with H&SC Section 25270.5Lc2i the preparation of an SPCC lan. <br />A complete copy of the facility's SPCC plan, certified by a Registered Professional Engineer, is <br />El 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 ill compliance with H&SC Section 25270.5(c). <br />This form constitutes a referral to the Regional Board Lor correction o theollowin violation. <br />✓The facility does not have a certified SPCC plan in place. <br />aware fthe <br />Aboveground <br />y of <br />The owner or operator ` as unI Board AbovgStorage <br />ound T nk Program bochu a wa pd <br />rov edt o <br />ElState Water Resources C <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 sWRCB, CWP Form AGT-1 (06/28/99) <br />Sacramento, CA 94244-2120 <br />