Laserfiche WebLink
FIED PROGRAM CONSOLIDATED FOWi f <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-FACILITY INFORMATION <br /> E: (One form per facility) <br /> TYPE OF ACTION ❑ 1.NEW PERMIT ® 5.CHANGE OF INFORMATION ❑ 7.PERMANENT FACILITY CLOSURE 400. <br /> (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 6.TEMPORARY FACILITY CLOSURE ❑ 9.TRANSFER PERMIT <br /> I. FACILITY INFORMATION <br /> TOTAL NUMBER OF USTs AT FACILITY 404. FACILITY ID# ' <br /> 4 (Agency Use Only) <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) _ 3. <br /> ARCO 02093 <br /> BUSINESS SITE ADDRESS 103. CITY 104. <br /> 3425 TRACY BLVD TRACY <br /> FACILITY TYPE ® 1.MOTOR VEHICLE FUELING ❑ 2.FUEL DISTRIBUTION 403. Is the facility located on Indian Reservation or 405. <br /> ❑ 3.FARM ❑ 4.PROCESSOR ❑ 6.OTHER Trust lands? ❑Yes ®No <br /> II PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 407, PHONE 40s. <br /> BP WEST COAST PRODUCTS LLC 714-670-3928 <br /> MAILING ADDRESS 409. <br /> P.O. BOX 6038 <br /> CITY 410. STATE 411. ZIP CODE 412. <br /> ARTESIA CA 90702 <br /> M. TANK OPERATOR INFORMATION <br /> TANK OPERATOR NAME 42x-1. PHONE 428-2 <br /> IQ <br /> BAL SING BAINS � <br /> 209 <br /> 835-1605 <br /> MAILING ADDRESS 428-3 <br /> 3425 TRACY BLVD <br /> CITY 428-4 1 STATE 428-5 ZIP CODE 428-6 <br /> TRACY CA 95376 <br /> IV. TANK OWNER INFORMATION <br /> TANK OWNER NAME 414. PHONE 415. <br /> COMPLIANCE DEPARTMENT 714-670-3928 <br /> MAILING ADDRESS 416. <br /> BP WEST COAST PRODUCTS LLC, P.O. BOX 6038 <br /> CITY 417. STATE 418, ZIP CODE 419. <br /> ARTESIA CA 90702 <br /> OWNER TYPE: ❑ 4.LOCAL AGENCY/DISTRICT ❑ 5.COUNTY AGENCY ❑ 6.STATE AGENCY 420. <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. 421. <br /> VI,PERMIT HOLDER INFORMATION <br /> r. .:.. <br /> Issue permit and send legal notifications and mailings to: El1.FACILITY OWNER E] 4.TANK OPERATOR 423 <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 legal requirements. <br /> APPI/I(CANT SIGN TURE DATE 424. PHONE 425. <br /> 714-670-3928 <br /> AP%.-ANT NAM (ptrint) 426. APPLICANT TITLE 427 <br /> JE NiFER M. MARINAS Environmental Compliance Specialist <br /> ARCO 02093,BELSHIRE ENVIRONMENTAL <br /> JFACES PAGE I OF 6 UPCF UST-A Rev.(12/2007) <br />