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'.MFIED PROGRAM CONSOLIDATED F <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY <br /> (One page per site) Page_of <br /> TYPE OF ACTION ❑L NEW PERMIT ❑3.RENEWAL PERMIT <br /> (Check ooe item only) ®5.CHANGE OF INFORMATION [I7.PERMANENTLY CLOSED SITE 40p <br /> Y) ❑4.AMENDED PERMIT (Specify change)Name Change ❑e.TANK REMOVED <br /> ❑6.TEMPORARY SITE CLOSURE <br /> I. FACILITY/SITE INFORMATION <br /> BUSINESS NAME IS.as FACILITY NAME or DRA-Doing Basins:As) 3_ FACILITY <br /> ARCO Facility No.0760 11:11 1. <br /> NEAREST CROSS STREET :,I OWNER TYPE ❑4.LOCAL AGENCY/DISTRICT- 402_ <br /> Lodi/Cherokee ® 1.CORPORATION ❑5.COUNTY AGENCY' <br /> BUSINESS 1.GAS STATION 3.FARM 5.COMMERCIAL 403. ❑2.INDIVIDUAL <br /> ❑6.STATE AGENCY* <br /> TYPE ❑2.DISTRIBUTOR [14.PROCESSOR [16.OTHER ❑3.PARTNERSHIP ❑7.FEDERAL AGENCY* <br /> TOTAL NUMBER OF TANKS 404 Is facility m Indian Reservation 405. -It owner of UST is a public agency: name of supervisor of division,section or 406. <br /> REMAINING AT SITE or trust lands? office which operates the UST. (This is the contact person for the tank records.) <br /> 4 ❑Yes ®No <br /> IL PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 407. PHONE 408. <br /> BP West Coast Products LLC 714-670-5402 <br /> MAILING OR STREET ADDRESS 409 <br /> P.O.Box 6038 <br /> CITY 410, STATE ZIP CODE 412 <br /> Artesia CA 90702-6038 <br /> PROPERTY OWNER TYPE ULCORPORATION 2.INDIVIDUAL Lj 4.LOCAL AGENCY/DISTRICT El 6.STATE AGENCY as <br /> ❑3.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> M.TANK OWNER INFORMATION <br /> TANK OWNER NAME 414. PHONE 415, <br /> BP West Coast Products LLC 714-670-5402 <br /> MAILING OR STREET ADDRESS 416, <br /> P.O.Box 6038 <br /> CITY 417 1 STATE 41a, ZIP CODE 419. <br /> Artesia CA 90702-6038 <br /> TANK OWNER TYPE 1.CORPORATION El 2.INDIVIDUAL Ll 4.LOCAL AGENCYIDISTRICT El 6.STATE AGENCY 4m. <br /> ❑3.PARTNERSHIP [15.COUNTY AGENCY [17.FEDERAL AGENCY <br /> IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY TK HQ 44Call 916 322-9669 if questions arise 421. <br /> V.PETROLEUM UST FINANCIAL RESPONSIBILITY <br /> INDICATE METHOD(s) ®1.SELF-INSURED [14.SURETY BOND [17.STATE FUND [110.LOCAL GOVT MECHANISM 432 <br /> [12.GUARANTEE ❑5.LETTER OF CREDIT [18.STATE FUND&CFO LETTER ❑99.OTHER: <br /> [13.INSURANCE ❑6.EXEMPTION ❑9.STATE FUND&CD <br /> VI.LEGAL NOTIFICATION AND MAILING ADDRESS <br /> Check one box to indicate which address should be used for legal notifications and nulling. <br /> Legal notifications and mailings will be sent to the tank owner unless box I or 2 is checked. ❑ 1.FACILITY [12. PROPERTY OWNER ®3.TANK OWNER 423. <br /> VII.APPLICANT SIGNATURE <br /> Certification: I certify that the information provided herein is one and accurate to the best of my knowledge. <br /> SIGNATURE OF APPLICANT DATE 424, 1 PHONE 425. <br /> CA". r A%Awk.$ 12/27/01 714-670-5402 <br /> NAME OF APPLICANT(print) 426. TITLE OF APPLICANT 427. <br /> Carlos Rodriguez Environmental Compliance Specialist <br /> STATE UST FACILITY NUMBER(A�me only) 428- 1998 UPGRADE CERTIFICATE NUMBER(Agemy am only) 429. <br /> (See Data Element 1,above. <br /> UPCF bwf2730(1/99)-6/37 http://www.unidocs.org Rev.04/17M <br />