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s LTIl , UNIFIED PROGRAM AGL� . �Y ( 'A) <br />-SPILL PREVENTION CONTROL AND COUNTERMEASURE. (SPCC) PLAN <br />STATUS/REFERRAL FORM <br />Mail a copy of the completed form to: <br />California Re conal Water Quality Control Board! <br />Attn: G,rn�1d <br />CA <br />Date: % / '11 b / 5D <br />CUPA Inspector: U f 6(A,' fc-�" <br />Address: �c/�► �JU��p� ' �" 3��w�' <br />CA <br />Phone: (141 ) "t 0 <br />332 <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: '(,i 4—f�K 1�l C i bA Q R(W Cif Al—f ' C— <br />Facility Address: 1,;L }W cR r- 1 6( K -e7 JiLb <br />Contact:RM(X i n Phone: <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 />F-1 <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 />ninu/pc a referral to the Regional Board for correction: of the ollc <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 />