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CERTIFIED UNIFIED PROGRAM AGENC kCUPA) <br /> SPILL PREVENTION CONTROL <br /> REFERRAL FORM ASURE (SPCC) PLAN <br /> CUPA <br /> Mail Copy of the completed form: Inspector: <br /> California Regional Water Quality Control Address: C <br /> Board INefOer Ave- , <br /> Attn: AV'Z ee,c,C P f e,�l ` <br /> loth �Sf�c,�C�ary CA �1,52� <br /> lafl( U cor fl \p""\ CA 5( -1 b f'� Phone: QTR) Y03 - <br /> Date: / <br /> 03 "Date: / 13 / 0 <br /> ns or <br /> iple storage <br /> The following facility is storing"petroleum"greater than 1,320 gaallonnk greater"Petroleum"meanlsoc udeloilmortany fraction <br /> tanks with a cumulative storage capacity lute <br /> thereof,which is liquid at 60 degrees <br /> ubtances compresedahrenheit eof a comp ex blend re and 14.7 of hydrocarbo s, such asogasoline pressure. <br /> This includes petroleum based ssused <br /> diesel,jet fuels, residual fuel d propanea as (LPG). Notes, some : um solvents,The backside ofdthis form)identifies storage tanksand <br /> substance <br /> that is not"petroleum" is liquid propane 9 <br /> facilities exempt from the state Aboveground Petroleum Storage Act SPCC requirement <br /> Facility Name: <br /> UNC �en < S Mailing Name: <br /> rn �(/� y Mailing Contact: <br /> Facility Contact: Contact's <br /> Contact's Phone0 Phone Number: <br /> Number: Mailing Address <br /> Facility Address <br /> ^ �, ^J b A (street address) <br /> (street address) G <br /> 0 / <br /> City city�" <br /> �j 7z q O State/Zip <br /> State2ip " <br /> PLEASE SELECT ONE OF THE FOLLOWING: <br /> The facilit is not in com liance with H&SC Section 25270.5(c); a SPCC Plan has not been re ared. <br /> This form constitute a referral to the Regional Board for correction of the following violation.The facility does <br /> a certified SPCC Plan in place. <br /> not have __OR-- <br /> The facility is in com liance with H&SC Section 25270.5 c the preparation of a SPCC Plan. <br /> ional Engineer, is <br /> ❑ A complete copy of the facility's SPCC Plana certifiet 8 houdby a rs per day. tered If the fail ty is not attended at least 8 hours t <br /> the facility,which is normally attended at le <br /> per day, the SPCC Plan is maintained at the nearest field office. <br /> round Proleum <br /> orage <br /> nk <br /> ❑ Please check here if a copy of the State WateoResources operator. Additiolnalbnfo gmation rgarding this tprogramacan <br /> Program brochure was provided to the owner <br /> be found at http://www.swrcb.ca.gov(click on 'Tanks/Landfills") <br /> SWRCB,CWP Form ACT-1(06/28/99) <br />