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AdIL <br /> FNIFIED PROGRAM CONSOLIDATED FOk7,I <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION—FACILITY INFORMATION(Oneform per facility) <br /> 400. <br /> TYPE OF ACTION ❑ 1.NEW PERMIT ® 5.CHANGE OF INFORMATION 7.PERMANENT FACILITY CLOSURE <br /> ❑ <br /> (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 6.TEMPORARY FACILITY CLOSURE ❑ 9.TRANSFER PERMIT <br /> I. FACILITY INFORMATION <br /> t. <br /> TOTAL NUMBER OF USTs AT FACILITY 404. FACILITY ID# — — <br /> 4 (Agency Use Only) <br /> 3. <br /> BUSINESS NAME(Same as FACILITY NAME or DBA—Doing Business As) <br /> ARCO 02076 103 CITY 104 <br /> BUSINESS SITE ADDRESS LORI <br /> 800 E KETTLEMAN LN 403 405, <br /> FACILITY TYPE ® I.MOTOR VEHICLE FUELING ❑ 2.FUEL DISTRIBUTION Is the facility located on Indian Reservation or <br /> ❑ Trust lands? ❑Yes No <br /> 3.FARM ❑ 4.PROCESSOR ❑ 6.OTHER <br /> ® <br /> II. PROPERTY OWNER INFORMATION <br /> aoi. PHONE aos. <br /> PROPERTY OWNER NAME <br /> BP WEST COAST PRODUCTS LLC 714-670-3928 <br /> 409. <br /> MAILING ADDRESS <br /> P.O. BOX 6038 410 an. ZIP CODE 412. <br /> EARTESIA <br /> STATE <br /> CA 90702 <br /> III. TANK OPERATOR INFORMATION428-t. PHONEata-z <br /> OPERATOR NAME <br /> PROMOD K TREHAN 209-334-3678 <br /> 428-3 <br /> MAILING ADDRESS <br /> 800 E KETTLEMAN LN ZIP CODE 428-6 <br /> 428-a rCz�� <br /> CITY <br /> LODI 95240 <br /> IV. TANK OWNER INFORMATION <br /> ala. PHONE 415. <br /> TANK OWNER NAME <br /> COMPLIANCE DEPARTMENT 714-670-3928 <br /> 416. <br /> MAILING ADDRESS <br /> BP WEST COAST PRODUCTS LLC, P.O. BOX 6038 418 LIP CODE 419. <br /> CITY 417 STATE <br /> ARTESIA CA 90702 <br /> ago. <br /> OWNER TYPE: ❑ 4.LOCAL AGENCY/DISTRICT ❑ 5.COUNTY AGENCY ❑ 6.STATE AGENCY <br /> ❑ 7.FEDERAL AGENCY ® 8.NON-GOVERNMENT <br /> V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY(TK)HQ 44- 1014111416151 Call the State Board of Equalization,Fuel Tax Division,if there are questions. <br /> alt. <br /> VI.PERMIT HOLDER INFORMATION <br /> 423 <br /> Issue permit and send legal notifications and mailings to: ❑ <br /> 1.FACILITY OWNER ❑ 4.TANK OPERATOR <br /> ® 3.TANK OWNER ❑ 5.FACILITY OPERATOR <br /> 406. <br /> SUPERVISOR OF DIVISION,SECTION,OR OFFICE(Required For Public Agencies Only) <br /> VII.APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that the information provided herein is true,accurate,and in full compliance with le al re uirements. 425 <br /> AP ICANT SIGNATURE DATE 424 PHONE <br /> j-5- 10 714-670-3928 <br /> L <br /> 426. APPLICANT TITLE 427 <br /> APP x I TN E print) <br /> JE'N IFER MARINAS Environmental Compliance Specialist <br /> 55loyb� - { <br /> UPCF UST-A Rev.(12/2007) _J <br />