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Ncv-13-2002 11:24am From-ARCO PRODUCTS +714-670-3095 T-817 P 001/007 F-535 <br /> IFIED PROGRAM CONSOLID,*TEU FG � O\ <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY <br /> (Onc page per site) Page_1-of�7 <br /> TYPE OF ACTION ❑1.NEW PERMIT ❑3.RENEWAL.Pf:RMIT 5.MVVGE,,F INFORMATION 0 7.PERMANENTLY CLOSED SITE 400• <br /> (Check una item only) M 4.AlvfENDED PERMIT (Specify changr.l []S.TANK i <br /> [16.TEMPORARY SITE CLOSURE <br /> L FACILITY/SITE INFORMATION <br /> BUSINESS NAME(34me as!FACILITY N,,-.?L'o:DBA-Domm 5usinu7l As) 3 Fi'CILITY �- <br /> Arco#6080,LATI.IROP �5 f A� IDtr F4 31 <br /> NEAREST CROSS STREPT 401 F CiLI I Y I JWNR ER TYPE [4. ()CAL <br /> I-5/LOUISE ® I CORI,ORATT(NJ C 5 cauNTY RERMWSERVICES i, <br /> SUSINESS ®1.GAS STATION 3.FARM [:15 COJIMCRCIAL 403 ❑2 NDC IDL'AL ❑6.STATE AGENCY" I <br /> TYPE ❑2.DISTRIBUTOR ❑4,PROCESSOR ❑6 OTHER ❑3 PAR'!r42RSHIP ❑7.FEll£feAL AGENCY" <br /> TOTAL NUMBER OF TANKS AO4 is facility on Indian Res,;tats),) 4W •If owner of US7 is a pubdc agency: name of supervisor of division,secnon ar 4Je. <br /> REIVIAIIQING AT SITE or trust NOW offrx which owrarca the UST (Thi;,is rho contact perxnn';or the tank records,) <br /> ' ' I <br /> 3 ❑Yes 0 No <br /> i <br /> T'I. PROPERTY OWNER!NFOIt'MATION <br /> PROPERTY OWNER NAME - - - 4117, ?I-JCNE aJa <br /> BP West Coam _ 530 308 0495 <br /> MAILING OR STREET ADDRESS 409 <br /> I P.O. BOX 6038 <br /> ' CITY 410. STATE. 41t 'LIP COU£ 412 <br /> ARTESIA CA 90702 <br /> i PROPERTY OWNER TYPE ® 1.CORPORATION: ? INOIvinUAl_ L7 4.1.0CA1 AGFNCv,DTSTRICT 0 6.57ATF,AGFNCY 413 <br /> i [13.PARTNFFSHIP ❑ S.COUN' Y AGENCY ❑7.FEDERAL AGENCY <br /> III TANK OWNER INFORM ATION <br /> TAN KOwN£R414. FHCNF 17, <br /> BP WEST COAST PRODUCTS LLC i <br /> MAILING OR STREETADDRESS - a 1 <br /> P.O. 30X_60?8 <br /> J <br /> CITY 4!7. Sr TATE 41R. ZIP CODE 41). <br /> ARTESIA CA 9070:. <br /> P'A\K 0 T•1'PE I,CORPOR.A'rt N 1 1V! GAL4.LOC>,L A EN YIDI"fR1G 6 STATE A ENCY 423 <br /> ❑3.PARTNERSHIP ❑5.COL NTY AGENCY ❑7 FEDERAL AGENCY <br /> 1V.BOARD OF EQUALIZATION UST STORAGI! FEE ACCOUNT NUMBER --- <br /> TY(TK)HQ 44- 0 4 i 4 1 6 1 5 1 Call (916)322-9669 if questions arise 4r <br /> V.PETROLEUM UST FINANCIAL RI.SPON'S'MILITY <br /> NMCATE METHOD(s) ®1 SE'.F-INSURED ❑4 SURETY BDND 0 7.STATE F'LT.) ❑10 LOCAL 30'-'T MECMANIsm 41, <br /> CL:,-RAN,rFE C35.LETTER OF CREDIT 0 8.STATE F'n ,�&CFO LETTER ❑99 OT4E R: <br /> ❑3,INSRANCE [3 6.EXEWTION ❑D.STATE FUD J&CD <br /> VI. LEGAL NOTIFICATION AND MAILING ADDRESS <br /> Chec"one box to wdi;;&w whielh address should ba used fx legal notifications and mailing. <br /> Lettai mmf,cntions arrd mai Ines wii!be sent fo the tank owner unless box 1 or 2 is checkrd. ❑ 1.FACILI'1 Y n 2. PROPERTY OWNER 3.TANK OWNER 421 <br /> 1�- V1I. APPLICANT SIGNATURE <br /> OUnnC,ad0l) I certify that the information prodded hoami 1s ume tsad 9Ccru"ate ro thm beat of n»knew <br /> �T .RE 0 PPLICANT - DATE - 434 1X Iv'C t+s. <br /> (! 1 i 1yZ 530 308 0495" <br /> INAME OF.kPPI_1CANT(print) 4=6 TITLE OF Ai TL.ICAYT 427 <br /> JOHN SCHETTER ENVIRON?YIE1;TAL COMPLIANCE <br /> STATE UST FACILITY!dL!NISEP,(Agency'aid ocly) 426 1998UPGR,,DECCR71FIC:ITENUMBER:Agencyusoonl.0 420 <br /> (Sae Data Element I,above. <br /> UPCF Hwlwrc-a(1/99)-1/2 http://%wkv.unidoes.org Rev.02/16/60 <br />