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:_SPILL PREVEN <br />Mail a copy of the completed form to: <br />California Regional Water Quality Control Board <br />Attn: O� Y101+t <br />0-V �2 w CQC ►� <br />2CXAmeu�'�"o , CA �- <br />CUPA Inspector: <br />a <br />54er Al, &L <br />Address: <br />Phone: ( y)9LL---q K 2 <br />Date: D l O'� / 0 <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: A a+ --r <br />SAg <br />Facility Address: I q 0 <br />Phone: <br />The Facility is in compliance with H&SC Section 25270 5Lc) the preparation of an SPCC Plan. <br />A complete copy of the facility's SPCC plan, certified by a Registered Professional Engineer, is <br />Elmaintained 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 />�u <br />72-(0 <br />The facility is not in compliance with H&SC Section 25270.5(c). <br />tis orm constitutes a referral to the Regional Board or correction o the ollowin vl !alio . <br />FO <br />The facility does not have a certified SPCC plan in place. r <br />N <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 />Division of Clean Water Programs ' <br />P.O. Box 944212 SWRCB, CWP Form AGT-1 (06/28199) <br />Sacramento, CA 94244-2120 <br />1 <br />