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�JNIFIEDTRQGRAMROGRAM AGENCY, <br /> SPILL PREVENTION CONTROL AND COUNTERMEAS (SPCC)PLAN <br /> STt1TUS/REFERRAL FORM: . <br /> Mail a copy of the completed form to: ' CUPA Inspector: <br /> -A I5_ 0kl A ✓LQ <br /> LlMd <br /> California Regional Water Quality Control Board Address: 6af tJQ�u�� w• E>T J <br /> Attn: Ca avnoid InouU AVE,-E,- ,'hAd �, <br /> P ��� (, . V\I <br /> O(J&�W Cit ci-�702 <br /> SGCUf� <br /> —,CA °15$27 <br /> 3 Phone: <br /> Date: / 22 l Ql <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 <br /> �Storage <br /> �Act SPCC requirement. <br /> Facility Name: <br /> Facility Address: �2�1 f 1 ���WuA� 1� <br /> VaAR-Ca <br /> Contact: ICL— �S Phone: ( W4,j <br /> F. not <br /> cility is in compliance with H&SCSection 25270 5(c) the Preparation ofan SPCC plmu. <br /> mplete copy of the facility's SPCC plan, certified by a Registered Professional Engineer,is <br /> tained at the facility,which is normally attended at least 8 hours per day. If the facility is <br /> ttended 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(or 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 /> State Water Resources Control Board <br /> Division of Clean Water Programs <br /> P.O.Box 944212 <br /> SWRCB,CwP Form AOT-1 (06/28199) <br /> Sacramento,CA 94244-2120 <br /> 1 <br />