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CERTIFL `N)FIED PROGRAM AGENCY (CT <br /> SPILL PREVENTION Wil- ROL AND COUNTERMEASURE PCC)PLAN <br /> STATUS/REFERRAL FORM <br /> Nlail a copy of the completed form to: CUPA Inspector: � (SOO VQL�-�L)hcz� <br /> California Regional Water Quality Control Board Address: <br /> Attn: 6q A.ivl � I o�AgaP — ?icy F. WPB AwA,v� J-KL-KJ Mc)v- <br /> +2D.,rh o-r RJ Sic. A — <br /> c��;,�rvl'P,vl�r�, <br /> CA a58Z1 Ir <br /> Phone:( ZC>57 �(Og <br /> Date: I l l 2W <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 /> FacilityName: /VI�/— <br /> Facility Address: 12A <br /> Contact: t'l�il-1'Lt VI Phone: LAOL4 'L <br /> The Facility is it, compliance with H&SC Section 25270.5(c2, the preparation of an SPCC plan' <br /> . <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 in compliance with H&SC Section 25270.5(c). <br /> FThis orm constitutes a re erral to the Regional Board or correction o the followingviolation. <br /> 01 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 Nater 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 SWRCB,CWP Form AGT-1 (06/28/99) <br /> Sacramento,CA 94244-2120 <br /> 1 <br />