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=1 ; CERTIr IED UNIFIED; PROGRAM AGENCY . %BUPA) u ' <br />SPII LPREVENTIONCONFROL ANMEASURE (SP <br />CC) <br />D GOUNIER <br />STATUS/REFERRAL FORM'.. <br />Mail a copy of the completed form to: <br />California Re Tonal Water Quality Control Board <br />Attn: <br />�,-Sl.0 ramer�-l—b , CA19 58 } <br />Date: 1 l/ S l 6 <br />CUPA Inspector: L1L T t'1 Ce _-fit-1 G <br />Address: <br />C 19 - <br />Phone: Q) G ( ) "t'Z <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. J N S <br />Facility Name: <br />Facility Address: 13 <br />Contact: ��.�i i�`� ��6`'`'"h S f Phone: (,9 �tj) �' — t✓� <br />Tlhe Fachlhty hs hn compliance with H&SC Section 25270 5(c) he preparation of an SPCC plan. <br />A complete copy of the facility's SPCC plan, certified by a Registered Professional Engineer, is <br />ed at least <br />hours er day. If the facility <br />El maintained aat le sthe c8lhours hper day, the SPCC pich is normally lan n is maint a ed at the nearest field office.hs <br />not attended <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 <br />el <br />P1tate `Vater Resources Control BoardfAbov gr o nd Tank Program brthe Abveground Petroleumoochure rage was rovided tAct. A coy of o <br />the owner or operator. <br />v cc: Carol Julian <br />i <br />o-0- °' 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 />