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UNIFIED PROGRAM CONSOLIDATED I-ORN <br /> 0NDERGROUND STORACE TANK <br /> OPERATING PERMIT APPLICATION— FACILITY INFORMATION <br /> I(1;ri�lirrrn;xr luulrl}t <br /> T1`Pt:O}'ACTION I NF 41 PI:RAtll' (] C"IIANGI ()f'NF()ItAIATION El 7 PE lit�l ltvLti' I'ACII_I 1'Y C"Ll7SC!C2F: �"' <br /> i('hcrA rorc acm.Hoh-1 , (lf-�yt 1NA1_PPRPaI'I' > ;p � r! I"E'MI Oli:�r@1 t AC Il fY('LOICIRi: ) TRANSf R PERP Irr <br /> I, FACILITY INFORMATION <br /> M 5AL NUR Mr—jK 11 USI S AA 61'•1( <br /> 2 <br /> FACtlITY1UA r <br /> BtISINL:SSNAhrE(Sa�en,rtirorT NAME on NiNw—les.As) r <br /> ARCO#06080 <br /> I3USIN7FSS Sl'I"L-AUU.riE:5S , _....,_..,,�_ <br /> 85 Nast Louise Avenue I,athro <br /> FACILITY'l-YP(. ® I MOTOR VEHICLE FUELINC1a0' }:c <br /> ❑ 2,FEIEI,UI$7i(lRt 1T10N is the faerhty IHemled on Indian Reservntinn Of <br /> FARM 4 PROCESSORQ h,U'ftilR Tnrst Ix.ids° -]Yes ®Na 1 <br /> Il. PROPERTY OWNER INFORMATION <br /> 71ROPI.R"r'YOWN—MNAME " "' "' 'a0=(714)6770-3928_.. --...r 410 <br /> BP West Coast Products LLC <br /> MAILING A .UR1iS <br /> _ _ a— <br /> P.O.Box 6038 <br /> STAT[ ZIP CODE <br /> Artesia _ CA ltt ' a„ <br /> 0703.6038 <br /> _ 11II. TANK OPERATOR INFORMATION <br /> TANK OPE1RA1'(3fe NAME 4'0 taE t7vE •-104 <br /> Jamal Kabaritl (209)983-9144 <br /> 4233 <br /> 85 Fast Louise Avenue <br /> .IP t�DE 413-6 <br /> Laths CA_ .. 95330 <br /> I'V. TANK OWNER INFORMATION <br /> tANK O . 11?NAME 414 PHQNE <br /> $r` <br /> BP West Coast Products LLC (714)670-3928 <br /> MAtX.1NCr ADDRESS aaa <br /> P.O.Box 6039 <br /> 1-r'Y 417 STATE 013 _ZITCOUI <br /> Artesia CA90702-6038 <br /> OWNER TYP1 j 4.I.00AE.AGENCY/DISTRICT ❑ S.COUNTY A(JFNCY Cj fi,STATE AUENCV +'-E <br /> i,FFDF.RAI ACiPNCY g.NON-GOVERNMENT <br /> V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NIJMBFR <br /> TY TtC)HC}4$- 0 4 1 4 6 5 call the state13attrd of>qunlizataar Fuel Tex Drvieinn if!Mere are questions Oar <br /> VL PERMIT.HOLDER INFORMATION <br /> Issue permit and send legal notificattons and mailings ro: [3 1,FACILITY 11 OWNER (J 4,TANK OPERATOR 4z3 <br /> 3.TANK OWNER [J 5;FACT ITY OPERATOR <br /> SUPERVISOR OF DIVISION,SECTION,OROFFICE(Required For Public Agencies Only) <br /> VtI.APPLICANT SIGNATURE <br /> ('!"K'I'IFtt:A'CIQN: !certif that Nte information rnvitled herein is true accurate and in full com lienee with Ocyal re utrclncnts. �"� <br /> APPI.iCAN'P S[GNATYIRE _ r�ATC: as PHONE -`{`""`4a <br /> '�Q/��/2�7® (714 b70-3938 <br /> APPLICANTNAMF.(printl a?r, APPt,lCANTTITLE _ "` —�_-uT <br /> R.C.Gossett F-,avironmental Carn fiance S et:iatist <br /> IiPC'F I.I.ST-A Rev.(13!2007) <br />