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IFIED PROGRAM CONSOLIDATED FOR PR#:PR0231861 FAC#:FA0003601 UNDERGROUND STORAGE TANKS -FACILITY D l g-U-D 3 (one page per site -71,93 TYPE OF ACTION ❑ I.NEW SITE PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 7.PERMANENTLY CLOSED SITE (Check one item only) ❑ 4.AMENDED PERMIT ❑ 8.TANK REMOVED ❑6.TEMPORARY SITE CLOSURE 400 I.FACILITY/SITE INFORMATION 130 S WILSON WAY,STOCKTON BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) ; FACILITYID# PR ID# ARCO STATION#5469* FA0003601 PR0231861 ` NEAREST CROSS STREET FACILITY OWNER TYPE WILSON 401 E:] 1. CORPORATION ❑ 4.LOCAL AGENCY/DISTRICT' ❑ 5.COUNTY AGENCY* BUSINESS ❑ 1 GAS STATION ❑ 3.FARM [:15.COMMERCIAL ❑ 2.INDIVIDUAL El 6.STATE AGENCY* ❑ [:]TYPE 2.DISTRIBUTOR ❑4.PROCESSOR 6.OTHER 403 ❑ 3.PARTNERSHIP ❑ 7.FEDERAL AGENCY' 402 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner ofUST is a public agency:name of supervisor of division,section or office which operates REMAINING AT SITE trustlands? the UST(This is the contact person for the tank records.) 404 ❑ Yes N No 405 406 II.PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE 408 714 670-5404 MAILING OR STREET ADDRESS 409 PO BOX 6038 CITY 410 STATE ... ZIP CODE 412 ARTESIA CA 90702-6038 PROPERTY OWNER TYPE N 1.CORPORATION ❑ 2.INDIVIDUAL ❑ 4.LOCAL AGENCY/DISTRICT ❑ 6.STATE AGENCY ❑3.PARTNERSHIP ❑ 5.COUNTY AGENCY ❑ 7.FEDERAL AGENCY 413 III.TANK OWNER INFORMATION TANK OWNER NAME 414PHONE 415 BP WEST COAST PRODUCTS LLC 714 670-5404 MAKING OR STREET ADDRESS 416 PO BOX 6038 CITY 411 STATE alg 1 ZIP CODE 419 ARTESIA CA 90702-6038 TANK OWNER TYPE N L CORPORATION ❑ 2.INDIVIDUAL 1:14.LOCAL AGENCY/DISTRICT ❑ 6.STATE AGENCY 420 ❑ 3.PARTNERSHIP ❑ 5.COUNTY AGENCY ❑ 7.FEDERAL AGENCY IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY(TK)HQ 44- 44-000506 1 Call(916)322-9669 if questions arise 421 V.PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) X❑ 1.SELF-INSURED ❑4.SURETY BOND ❑ 7.STATE FUND ❑ 10.LOCAL GOVT MECHANISM ❑2.GUARANTEE 1:15.LETTER OF CREDIT ❑ 8.STATE FUND&CFO LETTER ❑99.OTHER ❑3.INSURANCE ❑6.EXEMPTION ❑ 9.STATE FUND&CD 422 VI.LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. ® 1.FACILITY ❑2.PROPERTY OWNER ❑3.TANK OWNER 423 Legal notifications and mailing will be sent to the tank owner unless box I or 2 is checked. VII.APPLICANT SIGNATURE Certification-I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF APPLICANT DATE ata PHONE 425 NAME OF APPLICANT(print) 426 TITLE OF APPLICANT 427 STATE UST FACILITY NUMBER(For tical ue only) 428 1 1111 UPGRADE CERTIFICATE NUMBER(For local use only) 429 Is 1998 Compliant?N UPCF(1/99 revised)