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IFIED PROGRAM CONSOLIDATED FORK* PR #: PRO231416 1 FAC #: /FA0003627 \�� UNDERGROUND STORAGE TANKS - FACILITY (one page per site) TYPE OF ACTION ❑ LNEW SITE PERMIT E]3. RENEWAL PERMIT 5. CHANGE OF INFORMATION ❑ 7. PERMANENTLY CLOSED SITE (Check one item only) 4. AMENDED PERMIT ❑ 8. TANK REMOVED y ❑ 6. TEMPORARY SITE CLOSURE 400 I. FACILITY / SITE INFORMATION 3425 N TRACY BLVD, TRACY BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID# PR ID# _TJ 1 K & N FOOD & FUEL* FA0003627 I PRO 31416 NEAREST CROSS STREET FACILITY OWNER TYPE ❑ 4. LOCAL AGENCY/DISTRICT* TRACY 401 ® 1. CORPORATION ❑ 5. COUNTY AGENCY* 2. INDIVIDUAL ❑ 6. STATE AGENCY* BUSINESSC-] 1. GAS STATION E]3. FARM ❑ 5. COMMERCIAL TYPE 2. DISTRIBUTOR ❑ 4. PROCESSOR ❑ 6. OTHER 403 ❑ 3. PARTNERSHIP 402 ❑ 7, FEDERAL AGENCY* TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST 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 ® No 405 406 II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE CP S2.y CA 1 408 BP WEST COAST PRODU S LLC 71 MAILING OR STREET ADDRESS 409 PO BOX 6038 CITY 410 STATE 411 ZIP CODE 412 ARTESIA CA 90702-6038 PROPERTY OWNER TYPE ® 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 ' 414 PHONE 5b3 ZH lq 1 415 BP WEST COAST PRODUC S LLC 7 - MAILING OR STREET ADDRESS 416 PO BOX 6038 CITY 417 STATE 418 ZIP CODE 419 ARTESIA CA 90702-6038 TANK OWNER TYPE ❑9 1. CORPORATION ❑ 2. INDIVIDUAL ❑ 4. 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)/1. SELF-INSURED El4. SURETY BOND El7. STATE FUND E:110. LOCAL GOVT MECHANISM GUARANTEE El 5. LETTER OF CREDIT El 8. STATE FUND & CFO LETTE 42. 3. INSURANCE 1:16. 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. �i 2. PROPERTY OWNER ❑ 3. TANK OWNER 423 Legal notifications and mailing will be sent to the tank owner unless box 1 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. SIGNATUREAPPL NT 424 HONE 425 ,DATE TT N F APPLICA print) 426 TIT E OFPLICA T 42 �-- rOA I S ATE UST FACILITY NUMBER (For local tic mh) 428 1998 UPGRADE CERTIFICATE NUMBER (F Iocal use onh) 429 Is 1998 Compliant? Y UPCF (1/99 revised)