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IFIED PROGRAM CONSOLIDATED F61W <br /> TANKS \ \\ <br /> UNDERGROUND STORAGE TANKS - FACILITY ,\oti <br /> (One page per site) Page_of <br /> TYPE OF ACTION ❑I.NEW PERMIT ❑3.RENEWAL PERMIT ®5.CHANGE OF INFORMATION ❑7.PERMANENTLY CLOSED SITE 400. <br /> (Check one item only) ❑4.AMENDED PERMIT (Specify change) ❑8.TANK REMOVED <br /> ❑6.TEMPORARY SITE CLOSURE <br /> I. FACILITY/SITE INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3. 1 FACILITY <br /> ARCO Facility No. 06313 ID# i <br /> 1 <br /> NEAREST CROSS STREET 401. FACILITY OWNER TYPE ❑4.LOCAL AGENCY/DISTRICT* 402. <br /> SEC MAIN/INDUSTRIAL ® 1.CORPORATION ❑5.COUNTY AGENCY* <br /> BUSINESS 1.GAS STATION 3.FARM 5.COMMERCIAL 403. [12.INDIVIDUAL ❑6.STATE AGENCY* <br /> TYPE ❑2.DISTRIBUTOR [:14.PROCESSOR ❑6.OTHER ❑3.PARTNERSHIP [17.FEDERAL AGENCY* <br /> 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 406. <br /> REMAINING AT SITE or trust lands? office which operates the UST. (This is the contact person for the tank records.) <br /> 3 ❑Yes ®No N/A <br /> II. PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 407, PHONE 408, <br /> BP WEST COAST PRODUCTS LLC 714-670-5336 <br /> MAILING OR STREET ADDRESS 409. <br /> P.O.BOX 6038 <br /> CITY 4M STATE 411. ZIP CODE 412. <br /> ARTESIA I CA 90702-6038 <br /> PROPERTY OWNER TYPE E3 1.CORPORATION ❑2.INDIVIDUAL El 4.LOCAL AGENCY/DISTRICT El 6.STATE AGENCY 413. <br /> ❑3.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> III.TANK OWNER INFORMATION <br /> TANK OWNER NAME 414. PHONE 415. <br /> BP WEST COAST PRODUCTS LLC 714-670-5336 <br /> MAILING OR STREET ADDRESS 416. <br /> P.O.BOX 6038 <br /> CITY 417. 1 STATE 418. ZIP CODE 419. <br /> ARTESIA CA 90702-6038 <br /> TANK OWNER TYPE ® 1.CORPORATION ❑2.INDIVIDUAL [14.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- 0 4 1 1 1 4 1 6 1 5 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 GOV'T MECHANISM 422 <br /> ❑2.GUARANTEE ❑5.LETTER OF CREDIT ❑8.STATE FUND&CFO LETTER ❑99.OTHER: <br /> ❑3.INSURANCE ❑6.EXEMPTION ❑9.STATE FUND&CD <br /> VI.LEGAL NOTIFICATION AND MAILING ADDRESS <br /> Check one box to indicate which address should be used for legal notifications and mailing. <br /> Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ❑ 1.FACILITY [12. PROPERTY OWNER ®3.TANK OWNER 423. <br /> VII.APPLICANT SIGNATURE <br /> Certification: I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF APPLICANT DATE 424. PHONE 425. <br /> 5/17/02 714-670-5336 <br /> NAME OF APPLICANT(print) 426• TITLE OF APPLICANT 427. <br /> Nora Koskenmaki ENVIRNONMENTAL COMPLIANCE SPECIALIST <br /> STATE UST FACILITY NUMBER(Agency use only) 428• 1998 UPGRADE CERTIFICATE NUMBER(Agency use only) 429. <br /> (See Data Element 1,above. <br /> UPCF hwf2730(1/99)-2/1 http://www.unidoes.org Rev.04/17/00 <br />