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Y <br /> IED PROGRAM CONSOLIDATED FOAM <br /> UNDERGROUND STORAGE TANK ,l nll <br /> OPERATING PERMIT APPLICATION-FACILITY INFORMATIONE: <br /> tC�C �(o7$IO <br /> (One form per fa°ility) <br /> TYPE OF ACTION ® 1.NEW PERMIT ❑ 5.CHANGE OF INFORMATION [17.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# I. <br /> 4 (Agency Use Only) <br /> BUSINESS NAME(same as FACILITY NAME or DBA-Doing Business As) 3. <br /> ARCO 02130 <br /> BUSINESS SITE ADDRESS 103. CITY 104. <br /> 7906 N. EL DORADO ST. STOCKTON <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. PROPERTi'O" NER'INFORMA'TION <br /> PROPERTY OWNER NAME 407. PHONE 408, <br /> BP WEST COAST PRODUCTS LLC 714-670-3958 <br /> MAILING ADDRESS 409. <br /> P.O. BOX 6038 <br /> CITY 410. STATE 411. ZIP CODE 412. <br /> ARTESIA CA 90702 <br /> M. TASOPERATOR NFORMA' ©N <br /> TANK OPERATOR NAME 428-1. PHONE 428.2 <br /> PROMOD K TREHAN (209) 957-2987 <br /> MAILING ADDRESS 428-3 <br /> 7906 N. EL DORADO ST. <br /> CITY 428-4 STATE 428-5 ZIP CODE 428.6 <br /> STOCKTON � CA 95210 <br /> IV. TANK OWNER INFORMATION, <br /> TANK OWNER NAME 414. PHONE 415, <br /> BP WEST COAST PRODUCTS LLC 714-670-3958 <br /> MAILING ADDRESS 416. <br /> P.O. BOX 6038 <br /> CITY 417, 1 STATE 418, 1 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- 10 141 1 4161 5_T_ Call the State Board of Equalization,Fuel Tax Division,if there are questions. 421 <br /> VL PERMIT HOLDER INFORMATION <br /> Issue permit and send legal notifications and mailings to: [:11.FACILITY OWNER [:14.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 /> 'M.APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that thv4fihormtion provided herein is true,accurate and in full comp"ance with legal requirements. <br /> APPLICANT SIGNATURE DATE 424. PHONE 425_ <br /> 02 -7001714-670-3958 <br /> APPLICANT NAME(print) 426. APPLICANT TITLE 427 <br /> BRATZO BASAGOITIA Environmental Compliance Specialist <br /> Lf 5--o?90 <br /> UPCF UST-A Rev.(12/2007) <br />