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AM <br /> * <br /> IED PROGRAM CONSOLIDATED FO - <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY <br /> (One page per site) Page_of <br /> TYPE OF ACTION [11.NEW PERMIT [13.RENEWAL PERMIT ®5.CHANGE OF INFORMATION ❑7.PERMANENTLY CLOSED SITE <br /> (Check one item only) ❑4.AMENDED PERMIT (Specify change) ❑8.TANK REMOVED <br /> ❑6.TEMPORARY SITE CLOSURE <br /> L FACILITY/SITE INFORMATION <br /> BUSINESS NAMES.as FACUTY NAME or DBA-Doing Business An 3, FACILITY <br /> FA <br /> ARCO FacilityNo. 09600 <br /> NEAREST CROSS STREET 4o1. FACILITY OWNER TYPE 4.LOCAL AGENCY/DISTRICT* 002. <br /> WILSON WAYMARDING ®1.CORPORATION ❑5.COUNTY AGENCY* <br /> BUSINESS 1.GAS STATION 3.FARM 5.COMMERCIAL 003. ❑2.INDIVIDUAL ❑6.STATE AGENCY* <br /> TYPE ❑2.DISTRIBUTOR [14.PROCESSOR [16.OTHER ❑3.PARTNERSHIP ❑7.FEDERAL AGENCY* <br /> TOTAL NUMBER OF TANKS 404 Is facility on Indian Reservation 405. •If 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 /> 3 ❑Yes ®No N/A <br /> II. PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 467. PHONE 4o8. <br /> Thrifty Oil Corn na 562-921-3581 <br /> MAILING OR STREET ADDRESS 009, <br /> 13539 E.Foster Road <br /> CITY 419. STATE 411. 1 ZIP CODE 412. <br /> Santa Fe S rin S CA 90670 <br /> PROPERTY OWNER TYPE L CORPORATION 2.INDIVIDUAL Lj 4.LOCAL AGENCY/DISTRICT 6.STATE AGENCY 413. <br /> [13.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> M.TANK OWNER INFORMATION <br /> TANKOWNERNAME 414. PHONE 415. <br /> BP WEST COAST PRODUCTS LLC 714-670-5336 <br /> MAILING OR STREET ADDRESS 416' <br /> P.O.BOX 6038 <br /> CITY 417. 1 STATE 418, ZIP CODE 419. <br /> ARTESIA CA 90702-6038 <br /> TANK OWNER TYPE ®1.CORPORATION ❑2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT 6.STATE AGENCY 420. <br /> ❑3.PARTNERSHIP [15.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY TK HQ 44- 1 0 4 1 1 1 4 1 6 1 5 Call 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 422 <br /> ❑2.GUARANTEE ❑5.LETTER OF CREDIT [IS.STATE FUND&CFO LETTER ❑99.OTHER: <br /> ❑3.INSURANCE [16.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 mailing. <br /> Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked ❑ 1.FACILITY ❑2. PROPERTY OWNER ®3.TANK OWNER 423_ <br /> VII.APPLICANT SIGNATURE <br /> Certification: I certify that the information provided herein is nue and accurate to the best of my knowledge. <br /> SIGNATURE OF APPLICANT DATE 424. 1 PHONE 425. <br /> KA 1. 5/17/02 714-670-5336 <br /> NAME OF APPLICANT(print) 426. TITLE OF APPLICANT 427, <br /> Nora Koskenmaki ENVIRNONMENTAL COMPLIANCE SPECIALIST <br /> STATE UST FACILITY NUMBER(Agrney use only) <br /> 428. 1998 UPGRADE CERTIFICATE NUMBER(Agency use only) 429. <br /> (See Data Element 1,above. <br /> UPCF bwf2730(1/99)-2/1 http://www.unidocs.org Rev.04/17/00 <br />