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IFIED PROGRAM CONSOLIDATED FOR PR #: PRO231094 <br />FAC #: FA0003632 <br />UNDERGROUND STORAGE TANKS - FACILITY <br />(one page per site) <br />TYPE OF ACTION ❑ I. NEW SITE PERMIT ❑ 3. RENEWAL PERMIT ❑ 5. CHANGE OF INFORMATION ❑ 7. PERMANENTLY CLOSED SITE <br />(Check one item only) ❑ 4. AMENDED PERMIT s *ac change local =on*- ❑ 8. TANK REMOVED <br />❑ 6 TEMPORARY SITE CLOSURE 400 <br />I. FACILITY / SITE INFORMATION 7906 N EL DORADO ST, STOCKTON <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 <br />FACILITY ID# <br />PR ID# <br />1 <br />ARCO STATION #2130* <br />FA0003632 <br />I PR0231094 <br />NEAREST CROSS STREET 1 04 ry6I �yd 14. 401 <br />FACILITY OWNER TYPE ❑ 4. LOCAL AGENCY/DISTRICT* <br />EL DORADO r <br />® 1. CORPORATION <br />❑ 5. COUNTY AGENCY* <br />❑ 2. INDIVIDUAL ❑ 6. STATE AGENCY* <br />MM*4"6 K 1. GAS STATION ❑ 3. FARM ❑ 5. COMMERCIAL <br />TSE E] 2. <br />2. DISTRIBUTOR ❑ 4. PROCESSOR ❑ 6. OTHER 403 <br />3 PARTNERSHIP 402 <br />❑ 7. FEDERAL AGENCY* <br />TQTAL NUMBER OF TANKS <br />Is facility on Indian Reservation or <br />*If owner of UST is a public agency: name of supervisor of division, section or office which operates <br />REMAINING AT SITE <br />trustlands? <br />the UST (This is the contact person for the tank records.) <br />404 <br />❑ Yes ® No 405 <br />MANAGER 406 <br />MANAGER <br />II. PROPERTY OWNER INFORMATION <br />PROPERTY OWNER NAME 4071 <br />PHONE 15-0,S)�4 / q / 408 <br />BP WEST COAST PRODUCERS LLC <br />2 l <br />MAILING OR STREET ADDRESS 409 <br />PO BOX 6038 <br />CITY Oto <br />STATE 411 <br />ZIP CODE 412 <br />ARTESIA <br />CA <br />90702 <br />PROPERTY OWNER TYPE ® 1. CORPORATION ❑ 2. INDIVIDUAL ❑ 4. LOCAL AGENCY / DISTRICT ❑ 6. STATE AGENCY <br />❑ 3. PARTNERSHIP ❑ 5. COUNTY AGENCY ❑ 7. FEDERAL AGENCY 413 <br />III. TANK OWNER INFORMATION <br />TANK OWNER NAME 414 <br />PHONE 415 <br />BP WEST COAST PRODUCERS LLC <br />MAILING OR STREET ADDRESS 416 <br />PO BOX 6038 <br />CITY 417 <br />STATE 418 <br />ZIP CODE 419 <br />ARTESIA <br />1 CA <br />90702-6411 <br />TANK OWNER TYPE 1. CORPORATION ❑ 2. INDIVIDUAL ❑ 4. LOCAL AGENCY / DISTRICT ❑ 6. STATE AGENCY 420 <br />❑ 3. PARTNERSHIP ❑ 5. COUNTY AGENCY ❑ 7. FEDERAL AGENCY <br />IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br />TY (TK) HQ 44- 44-000506 1 Call (916) 322-9669 if questions arise 421 <br />V. PETROLEUM UST FINANCIAL RESPONSIBILITY <br />INDICATE METHOD(s) ❑ 1. SELF-INSURED ❑ 4. SURETY BOND ❑ 7. STATE FUND ❑ 10. LOCAL GOVT MECHANISM <br />❑ 2. GUARANTEE ❑ 5. LETTER OF CREDIT ❑ 8. STATE FUND & CFO LETTER 9199. OTHER <br />1�3. INSURANCE ❑ 6. EXEMPTION ❑ 9. STATE FUND & CD 422 <br />VI. LEGAL NOTIFICATION AND MAILING ADDRESS <br />Check one box to indicate which address should be used for legal notifications and mailing. ® 1. FACILITY ❑ 2. PROPERTY OWNER ❑ 3. TANK OWNER 423 <br />Legal notifications and mailing will be sent to the tank owner unless box 1 or 2 is checked. <br />VII. APPLICANT SIGNATURE <br />Certification - I certify that the information provided herein is true and accurate to the best of my knowledge. <br />SIGNAT OF APPLICANT <br />DATE 424 <br />PHONE 425 <br />1 <br />NAME OF APPLICA (pnt) o 426 <br />TITLE OF APP ICAN 27 <br />L <br />STATE UST FACILITY NUMBER (For local ue only) 428 <br />1998 UPGRADE CERTIFICATE NUMBER (F oval use only) 429 <br />Is 1998 Compliant? Y <br />UPCF (1/99 revised) <br />I� <br />