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CER 'IED yUNIFIFD PROGRAM AGENC CIJPA) <br />SPILL PREVENTION CONTROL AND:.GOLTNTERMEasURE (SPCC) PLAN <br />-.. <br />•: STATUS/REFERRAL FORM <br />Mail a copy of the completed form to: <br />Califo a Re conal Watery Quality Control Board <br />Attn: :/�11U� a �OI.I.0 <br />SQ , CA <br />Date: 4 / 2el- / G) <br />CUPA Inspector: b 1 `S(DYA f-()RV4)1PCrJ <br />Address: <br />--�--�vi , CP\ q,::;2o "z <br />Phone: (2 -0`t - <br />(A (A- gZLA 9 <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,) is liquid at 60 degrees Fahrenheit temperature and 14.7 <br />petroleum based substances comprised of a <br />pounds per square inch absolute pressure. This includes <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:= <br />Facility Address: <br />3Q S. <br />Lc�-J-"rc) p GA q"5-3 <br />c4l: <br />Contact: -Dun I -Vv Phone: ( ?(70, ) 00SA— 2Y 53 <br />The FaciliLE is in compliance 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 />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 />016 <br />The facility is not in compliance with H&SC Section 25270.5(c). <br />This form constitutes a re erral to the Re Tonal Board Lor correction o the following violation. <br />The facility does not have a certified SPCC plan in place. <br />orage Act. A <br />y of <br />The owner or operator was unaware <br />of Board , the Above goo nd Tank Program bveground Petroleum rochure ochu a wa prove <br />provided to <br />State Nater Resources Co <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 />