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CERTIF" � T TN1FIED,PROGRAM AGENCY.(('T ro^),; <br /> SPILL PREVENTIG NTROL AND COUNTERMEASt -,PCC)PLAN <br /> w <br /> STATU3/REFERRAL FORM <br /> Mail a copy of the completed form to: CUPA Inspector:A I ISM J0 Kq <br /> California Regional Water Quality Control Board Address:i�icaq u,t4A <br /> Attn: ✓I o I d (r)a u 3D4 E INe lee s- 1/e,wtA ,Sr Df <br /> SaGI a,w ,CA� <br /> 3003 1 Phone: <br /> Date: 7 /,9-0 CO <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 Storage Act SPCC requirement. <br /> Facility Name:5i Dbor l c ,Y,I <br /> Facility Address: 07u r WDD� war ��1�� <br /> 163 3 7 <br /> Contact: �I I I Pa,E,w► r�Se Phone: ( a <br /> The Facility is in compliance with SCSection 25270.5(c), the preparation of an SPCC plan. <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 /> The facility is not its 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 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 /> e Division of Clean Water Programs <br /> 4 �yO I P.O.Box 944212 <br /> Sacramento,CA 94244-2120 SWRCB,CWP Form AGT-1 (06/28/99) <br /> 1 <br />