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CERTIF UNIFIED PROGRAM AGENCY <br /> SPILL PREVENTIQ1., k�ONTROL AND COUNTERMEASL . (SPCC)PLAN <br /> STATUS/REFERRAL FORM <br /> form to: CUPA Inspector: AS6,11 <br /> Mail a copy of the completed <br /> California ReTonal Water Quality Control Board Address: STC- r-V1 V <br /> Attn: 6,-1. In n I d (o o f - 36N E. A E411 r A 0 <br /> 34 2,) Rouh1z1 Rel S�ocACtmjCAgSZDL <br /> S2Cya ,CA Phone: (20q <br /> Date: 9 /zZ /0 <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 e-Tempt from the state <br /> Aboveground Petroleum Storage Act SPCC requirement.. �, <br /> Facility Name: v`-*o l <br /> Facility Address: 7Qp l C I'D QA hu <br /> ROK 32 IVl <' �c G15�3(n <br /> Contact: S Phone: 9Z6- 70S <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 /> 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 /> 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 Water Resources Control Board,Aboveground Tank Program brochure was provided to <br /> the owner or operator. <br /> cc: Carol Julian <br /> o 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 i (06/28/99) <br /> 1 <br />