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CERTIFIEF VIED PROGRAM AGENCY (CUI <br /> -SPILLPREVENTION L.,: dTROL AND COUNTERMEASURE ?CC)PLAN <br /> ::STATUS/REFERRAL FORM:. <br /> • � CUPA Inspector: PCl lSO <br /> Mail a copy of the completed form to: v �'L_L��"� ..ULI�• <br /> Califo*Re ional Water QualitycontrolBoard Address: <br /> �-sr_ Env► Y <br /> Attn: <br /> ,CA Phone: ( 2�A) <br /> Date: <br /> The following facility is storing"petroleum"in a single storage <br /> tonk than atter than 660 g lions or in <br /> multiple storage tanks with a cumulative storage capacity greater <br /> means crude oil,or any fraction thereof,which <br /> This includes peuid at h-oleumes Fahrenheit based substancescomprisederature nof 14.7 7 <br /> pounds per square inch absolute p et fuels,residual fuel oils,lubricants,some <br /> complex blend of hydrocarbons,such as gasoline,diesel,j <br /> petroleum solvents, and used oils. Ap example of a substance that is not"petroleum" is liquid propane <br /> gas(LPG). Note: The backside ofh SPCC uirementorage tanks and facilities exempt from the state <br /> Aboveground Petroleum Storage A requirement. <br /> Facility Name: <br /> Facility Address: <br /> n <br /> Contact: 1vy/1 (�(a.l Vl�s — Phone: <br /> The Facility is u: compliance►vith H&SC Section 25270.5 c the preparation o an SPCC plait. <br /> A complete copy of the facility's SPCC plan,certified by a Registered Professional Engineer,'ilitv is <br /> maintained at the facility,which is normally attended <br /> is least fined at hours the nearest fer ield office.day. If the facility's <br /> not attended at least 8 hours per day,the SPCC p <br /> The facility is not in compliance with H&SC Section 25270.5(c). <br /> FoThe <br /> form constitutes a re erral to the Regional Board or correction o the ollowin violation. <br /> acilitydoes not have a certified SPCC plan in place. <br /> y of <br /> The owner or operator was unawareof the <br /> Aboe Aboveground ound Tank Program brochure was rop provided to <br /> State Water Resources Control Bo g <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 /> 1 <br />