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CERTIF IED PROGRAM AGENCY,(. <br />SPILL'PREVENTIO NTROL AND COUNTERMEAS PCC) PLAN <br />;. STATUS/REFERR.AL FORM . . <br />Mail a copy of the completed form to: ' CUPA Insppeect�olr: A h 7�I o I �-�CJGQ7C� �( t� <br />California Regional Water Quality Control Board Address: '.t v tK.vK.V � N I l ` r �QW <br />Atm: (a fly yio I(A sol _em i imvt.vtt o Dzc 0 <br />Dr12ondstA ,ICED„C1t <br />,CA✓pa- <br />,3CO3 Phone: ( -2� ) t be -0b 47 <br />Date: ,3 / 31 / ;k000 <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 front the state <br />Aboveground Petroleum Storage Act SPCC requirement. <br />Facility Nam <br />Facility Address: (345 W LaAkso� hel A kk <br />WyAk C)k CA g5--�-3(o <br />Contact: Phone:( 2J51) <br />The Facility is it, compliance with H&SC Section 25270-5(c), the preparation o(an SPCC plait. <br />A complete copy of the facility's SPCC plan, certified by a Registered Professional Engineer, is <br />❑ <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 (or correction of the (ollowine violation. <br />F1The facility does not have a certified SPCC plan in place. <br />he 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 />v cc: Carol Julian <br />State Water Resources Control Board <br />4{26�w Division of Clean Water Programs <br />P.O. Box 944212 <br />Sacramento, CA 94244-2120 SWRC8, CWP Form AGT-1(06/28/99) <br />