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IFIED PROGRAM CONSOLIDATED FOMI TANKS UNDERGROUND STORAGE TANKS - FACILITY (One page per site) Page_of TYPE OF ACTION [11.NEW PERMIT ❑3.RENEWAL PERMIT ®5.CHANGE OF INFORMATION ❑7.PERMANENTLY CLOSED SITE 400 (Check one item only) ❑4.AMENDED PERMIT (Specify change) Name Change ❑8.TANK REMOVED ❑6.TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3, FACILITY ARCO Facility No.02186 ID# 1. NEAREST CROSS STREET 401. FACILITY OWNER TYPE ❑4.LOCAL AGENCY/DISTRICT* 402. N.California Street/Alpine Avenue ®1.CORPORATION [15.COUNTY AGENCY* BUSINESS ® 1.GAS STATION ❑3.FARM [15.COMMERCIAL 403 ❑2.INDIVIDUAL ❑6.STATE AGENCY* TYPE ❑2.DISTRIBUTOR [:14.PROCESSOR [16.OTHER ❑3.PARTNERSHIP ❑7.FEDERAL AGENCY* 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. REMAINING AT SITE or trust lands? office which operates the UST. (This is the contact person for the tank records.) 03 ❑Yes ®No II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407. PHONE 408. Catherine R.Bevanda MAILING OR STREET ADDRESS 409. P.O.Box 901297 CITY 410. STATE 411. ZIP CODE 412. Palmdale I CA 93590-1297 PROPERTY OWNER TYPE 1.CORPORATION X 2.INDIVIDUAL El 4.LOCAL AGENCY/DISTRICT 6.STATE AGENCY 413. [:13.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY III.TANK OWNER INFORMATION TANK OWNER NAME 414. PHONE 415. BP West Coast Products LLC 714-670-5402 MAILING OR STREET ADDRESS 416. P.O.Box 6038 CITY 417. STATE 418. ZIP CODE 419. Artesia CA 90702-6038 TANK OWNER TYPE 1.CORPORATION 2.INDIVIDUAL Ll 4.LOCAL AGENCY/DISTRICT Ej 6.STATE AGENCY 420. [13.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 1 1 1 1 1 1 1 Call(916)322-9669 if questions arise 421. V.PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) ®1.SELF-INSURED ❑4.SURETY BOND ❑7.STATE FUND ❑10.LOCAL GOVT MECHANISM 422 ❑2.GUARANTEE [15.LETTER OF CREDIT [18.STATE FUND&CFO LETTER ❑99.OTHER: ❑3.INSURANCE ❑6.EXEMPTION ❑9.STATE FUND&CD VI.LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box I or 2 is checked. ❑ 1.FACILITY ❑2. PROPERTY OWNER ®3.TANK OWNER 423. VII.APPLICANT SIGNATURE Certification: I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF APPLICANT DATE 424. 1 PHONE 425. tfs /. _-e'Oe.&Wg,�8- 12/27/01 (714)670-5402 NAME OF APPLICANT(print) 426. TITLE OF APPLICANT 427. Carlos Rodriguez Environmental Compliance Specialist STATE UST FACILITY NUMBER(Agency use only) 428. 1998 UPGRADE CERTIFICATE NUMBER(Agency use only) 429. (See Data Element 1,above. UPCF hwf2730(1/99)-16/37 http://www.unidocs.org Rev.04/17/00