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uIvIFIED PROGRAM CONSOLIDATED FORivi <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-FACILITY INFORMATION <br /> (One form per facility) <br /> TYPE OF ACTION ❑ 1.NEW PERMIT ® S.CHANGE OF INFORMATION ❑ 7.PERMANENT FACILITY CLOSURE 400. <br /> (Check one item only) E] 3 RENEWAL PERMIT F16.TEMPORARY FACILITY CLOSURE El 9.TRANSFER PERMIT <br /> L,,FACIiITX INFORMATION <br /> TOTAL NUMBER OF USTs AT FACILITY 404. FACILITY ID <br /> 3 (Agency Use Only) r <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3' <br /> ARCO 02133 <br /> BUSINESS SITE ADDRESS 103. CITY 104. <br /> 2908 BENJAMIN HOLT DR STOCKTON <br /> FACILITY TYPE ® 1.MOTOR VEHICLE FUELING El2.FUEL DISTRIBUTION aol. Is the facility located on Indian Reservation or 405. <br /> ❑ 3.FARM ❑ 4.PROCESSOR ❑ 6.OTHER Trust lands? ❑Yes ®No <br /> II. PROPERTY OVITGi INFORMATION <br /> PROPERTY OWNER NAME 40�. PHONE 409. <br /> BP WEST COAST PRODUCTS LLC 714-670-3928 <br /> 409. <br /> MAILING ADDRESS <br /> P.O. BOX 6038 <br /> CITY a1o. STATE 411. ZIP CODE a12. <br /> ARTESIA CA 90702 <br /> III TANK OPERATOR INFORNIATIQN <br /> TANK 0PERATORNAME 428-1• PHONE 428-2 <br /> LAWRENCE WIGHT (209) 478-5552 <br /> 428.3 <br /> MAILING ADDRESS <br /> 2908 BENJAMIN HOLT DR <br /> CITY az9-4 STATE a28-5 ZIP CODE 429-6 <br /> STOCKTON CA 95207 <br /> ,,' .1V.';TANK OWNER INFORMATION <br /> TANK OWNER NAME Ota. PHONE als. <br /> COMPLIANCE DEPARTMENT 714-670-3928 <br /> 416, <br /> MAILING ADDRESS <br /> BP WEST COAST PRODUCTS LLC, P.O. BOX 6038 <br /> CITY 417. STATE 419- ZIP CODE 419. <br /> ARTESIA ICA 90702 <br /> OWNER TYPE: [14.LOCAL AGENCY/DISTRICT ❑ 5.COUNTY AGENCY El 6.STATE AGENCY ago. <br /> ❑ 7.FEDERAL AGENCY ® 8.NON-GOVERNMENT <br /> V..BOARD:.OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> .:. - 421 <br /> TY(TK)HQ 44- 0 4 1 4 6 75 1 Call the State Board of Equalization,Fuel Tax Division,if there are questions. <br /> VI PERNIITOLDER INFORMATION <br /> j : .'i H '•s .4z3 <br /> Issue permit and send legal notifications and mailings to: E] 1.FACILITY OWNER ❑ 4.TANK OPERATOR <br /> ® 3.TANK OWNER ❑ 5,FACILITY OPERATOR <br /> 406. <br /> SUPERVISOR OF DIVISION,SECTION,OR OFFICE(Required For Public Agencies Only) <br /> MY APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that the information provided herein is true,accurate,and in full compliance with letral requirements. <br /> APPLICANT SIGN URE DATE 424. PHONE - 425. <br /> 714-670-3928-: <br /> az6. an <br /> APPtIWT N print) <br /> JENNIF 1E 1R M. MARINAS Environmental Compliance Specialist <br /> UPCF UST-A Rev.(12/2007) /.I J '•,1, u ` - <br />