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/ t.rFIED PROGRAM CONSOLIDATED FORM.- TANKS O .TANKS b 1 UNDERGROUND STORAGE TANKS - FACILITY (One page per site) Page_of TYPE OF ACTION ❑1.NEW PERMIT ❑3.RENEWAL PERMIT Z 5.CHANGE OF INFORMATION 00. (Check one item only) ❑4.AMENDED PERMIT (Specify chane ❑T PERMANENTLY CLO$bB&IT®I' t O ( pe y g ) ❑8.TANK REMOVED ll//�V��..11!!.�JJVVjI�� [16.TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION BUSINESS NAM E(Sarno so FACILITY NAME or DBA-Doing Business As) 3, FACILITY ARCO FacilityNo. 06335 IDk F/` 1 7 I NEAREST CROSS STREET 401,401. FACILITY OWNER TYPE 4.LOCAL AGENCY/DISTRICT" 402, (� ARCH/HWY 99 `D J F SAreA, Z 1.CORPORATION ❑5.COUNTY AGENCY' BUSINESS 1.GAS STATION 3.FARM 5.COMMERCIAL 402. ❑2.INDIVIDUAL ❑6.STATE AGENCY* TYPE [12.DISTRIBUTOR [14.PROCESSOR [16.OTHER ❑3.PARTNERSHIP ❑7.FEDERAL AGENCY' TOTAL NUMBER OF TANKS 404 Is facility on Indian Reservation 405. •If owner of UST is a public agency:name of supervisor of division,section or 405. REMAINING AT SITE or trust lands? office which operates the UST. (This is the contact person for the tank records.) 3 ❑Yes Z No N/A II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407. PHONE qpg, BP WEST COAST PRODUCTS LLC 714-670-5336 MAILING OR STREET ADDRESS 409 P.O.BOX 6038 CITY 410, 1 STATE 411. ZIP CODE 412. ARTESIA CA 90702-6038 PROPERTY OWNER TYPE N 1.CORPORATION El 2.INDIVIDUAL LI 4.LOCAL AGENCY/DISTRICT LJ6.STATEAGENCY 41a [13.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY III.TANK OWNER INFORMATION TANKOWNERNAME 414. PHONE 415. BP WEST COAST PRODUCTS LLC 714-670-5336 MAILING OR STREET ADDRESS 416. P.O.BOX 6038 CITY 417. 1 STATE 418, ZIP CODE 419. ARTESIA CA 90702-6038 TANK OWNER TYPE Z 1.CORPORATION ❑2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT ❑6.STATE AGENCY 420. ❑3.PARTNERSHIP ❑5.COUNTY AGENCY [17.FEDERAL AGENCY IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 1 0 4 1 1 1 4 1 6 1 5 1 Call 916 322-9669 if questions arise 421. V.PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) ®1.SELF-INSURED ❑4.SURETY BOND ❑7.STATE FUND ❑10.LOCAL GOVT MECHANISM 422 ❑2.GUARANTEE ❑5.LETTER OF CREDIT [IS.STATE FUND&CFO LETTER [199.OTHER: ❑3.INSURANCE ❑6.EXEMPTION [19.STATE FUND&CD VI.LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. - Legal notifications and mailings will be sent to the rank owner unless has 1 or 2 is checked. ❑ 1.FACILITY ❑2. PROPERTY OWNER Z 3.TANK OWNER 423, VII.APPLICANT SIGNATURE Certification: I certify that the information provided herein is true and accurate W the best of my knowledge. SIGNATURE OF APPLICANT DATE 424 PHONE 425 5/17/02 714-670-5336 NAME OF APPLICANT(print) 426 TITLE OF APPLICANT 427 Nora Koskenmaki ENVIRNONMENTAL COMPLIANCE SPECIALIST STATE UST FACILITY NUMBER(Agency use only) 428, 1998 UPGRADE CERTIFICATE NUMBER(Agency use only) 429, (See Data Element 1,above. UPCF hwR730(1/99)-2/1 hftp://www.unido".org Rev.04/17/00