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STATE OF CALIFORNIA WATER RESOURCES CONTROL BOARD <br /> FORM AA': UNDERGROUND STORAGE TANK PROGRAM <br /> SITE FACILITY/SITE, INFORMATION and/or PERMIT APPLICATION <br /> COMPLETE THIS FORM FOR EACH FACILITY/SITE 5-30 <br /> y <br /> MARK ONLY ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT Z] 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED SITE 7..4 <br /> ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY SITE CLOSURE a <br /> I. FACILITY/SITE INFORMATION & ADDRESS— (MUST BE COMPLETED) W <br /> CO <br /> FACILITY/SITE NAME CARE OF ADDRESS INFORMATION <br /> BP Chemicals Inc. c/o Barney Swearingen <br /> ADDRESS NEAREST CROSS STREET ✓BNbelOpk 0 PARTNENSIIP ❑ STATE-AGENCY <br /> 3437 56uth Airport Way Industrial Road 0 COSPOPATION 0 LOCUAGEN 0 FEDEPALAGENa <br /> ❑ INDIVIDUAL 0 DDUNTY AGENCY <br /> CITY NAME STATE ZIP CODE SITE PHONE X WITH AREA CODE 1 <br /> Stockton CA 95206 (209)982-0160 <br /> TYPE OF BUSINESS. ❑ 2 DISTRIBUTOR ❑ 4 PROCESSOR ✓Box if INDIAN EPA ID X <br /> RESERVATION or pof TANK'X <br /> ❑ 1 GAS STATION ❑ 3FARM ❑ 50THER TRUST LANDS ❑ CAD 009189069 AT THIS SITE j <br /> EMERGENCY CONTACT PERSON(PRIMARY) EMERGENCY CONTACT PERSON(SECONDARY) <br /> DAYS: NAME(LAST,FIRST) PHONE X WITH AREA CODE DAYS: NAME(LAST.FIRST) PHONE X WITH AREA CODE <br /> Swearingen, Barney (209)982-0160 Kitagawa, Lon (209)982-0160 <br /> NIGHTS: NAME(LAST.FIRST) PHONE X WITH AREA CODE NIGHTS: NAME(LAST,FIRST) PHONE X WITH AREA CODE <br /> Same (209)478=6831 Same (209)948-3339 <br /> 11. PROPERTY OWNER INFORMATION & ADDRESS — (MUST BE COMPLETED) <br /> NAME CARE OF ADDRESS INFORMATION <br /> BP Chemicals Inc. <br /> MAILING or STREET ADDRESS Box to indicate ❑ PARTNERSHIP 0 STATE-AGENCY <br /> Almondsbur CORPORATION ❑ LOCAL-AGENCY 0 FEDERAL-AGENCY <br /> y 0 INDIVIDUAL 0 COUNTY-AGENCY <br /> CITY NAME STATE ZIP CODE PHONE 4,WITH AREA CODE <br /> United Kingdom BS12 4QD T0454) 201040 <br /> III. TANK OWNER INFORMATION &ADDRES COMPLETED) <br /> NAME RKRR7HEALTH <br /> V DE OF ADDRESS INFORMATION <br /> BP Chemicals Inc. <br /> MAILING or STREET ADDRESS ✓Bax To md,i .W 0 PARTNERSHIP 0 STATE-AGENCY <br /> 3437 South Airport Way J 911 1 890 CORPORATION 0 LOCAL-AGENCY 0 FEDERAL-AGENCY <br /> p y 0 INDIVIDUAL 0 COUNTY-AGENCY <br /> CEt <br /> CITY NAME PUBLICODE <br /> ERV S ZIP <br /> 95206 CODE PH(209)982ONE#WITH p0160 <br /> 1149404 <br /> Stockton <br /> IV. LEGAL NOTIFICATION AND BILLING ADDRESS <br /> CHECK ONE(1)BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR BOTH LEGAL NOTIFICATION AND BILLING: I. ❑ it. ❑ If. ❑ <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED 8 SI ATURE DATE <br /> B. Swearingen / 2-5-90 <br /> LOCAL AGENCY USE ONLY <br /> COUNTY k JURISDICTION R AGENCY X FACILITY ID If If of TANKS at SITE <br /> zl= I I 1 10 <br /> CURRENT LOCAL AGENCY FACILITY IDX APPROVED BY NAME PHONE X WITH AREA CODE <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> LOCATION CODE CENSUS TRACT X SUPERVISOR-DISTRICT CODE BUSINESS PLAN FILED DATE FILED <br /> 13 , 2-'5-- YES 0 NO ❑ D <br /> CHEC X PERMIT AMOUNT SURCHARGE AMOUNT FEECODE RECEIPT It BY: <br /> CIf <br /> THIS FORM MUST BE ACCOMPANIED BY AT LEAST"'OR MORE TANK PERMIT FORM'B'APPLICATION(SI,UNI FSS THIS IS A CHANGE OF SITE INFORMATION ONLY. <br /> FORM A S-2-88) <br /> DATA PROCESSING COPY <br />