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CERTIFT-- TNIFIED PROGRAM AGENCY (CT TPA),",. CER, SPILL PREVENTIO. ATROL AND,COUNTERIVIEASL PCC) PLAN . :.:8TATUS/ ,EFERRAL FORM Mail a copy of the completed form to: California Regional Water Quality Control Board Attn: ,CAS v Date: 3 / ( V / o d CUPA Inspector: 5 ev�) Address:-mgdam cliq Phone: (,2 0 ) 4// The following facility is storing "petroleum" in a single storage tank greater than 660 gallons or in multiple storage tanks with a cumulative storage capacity greater than 1,320 gallons. "Petroleum" means crude oil, or any fraction thereof, which is liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure. This includes petroleum based substances comprised of a complex blend of hydrocarbons, such as gasoline, diesel, jet fuels, residual fuel oils, lubricants, some petroleum solvents, and used oils. Ap example of a substance that is not "petroleum" is liquid propane gas (LPG). Note: The backside of this form identifies storage tanks and facilities exempt from the state Aboveground Petroleum Storage Act SPCC requirement. n Facility Name: Facility Address: %C 71 ae�q , C�1 �j ��S— Contact: �( —d--1(� e Phone: (O' ) er � ) 1 l �1 P6 ()-2— The Facility is in compliance with H&SC Section 25270.5(c2, the preparation of an SPCC pla)t. A complete copy of the facility's SPCC plan, certified by a Registered Professional Engineer, is maintained at the facility, which is normally attended at least 8 hours per day. If the facility is not attended at least 8 hours per day, the SPCC plan is maintained at the nearest field office. The facility is not in compliance with H&SC Section 25270.5(c). This form constitutes a referral to the Regional Board for correction of the following violation. The facility does not have a certified SPCC plan in place. The owner or operator was unaware of the Aboveground Petroleum Storage Act. A copy of the State Water Resources Control Board, Aboveground Tank Program brochure was provided to the owner or operator. cc: Carol Julian State Water Resources Control Board Division of Clean Water Programs P.O. Box 944212 Sacramento, CA 94244-2120 SWRCB, CWP Form AGT-1 (06/28/99)