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CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 26-30-2021-OPER FACILITY NAME AND LOCATION PERMITTEE VETERANS ADMINISTRATION MEDICAL Loren Cheel CENTER Portland VA Medical Center 3710 SW US VETERANS HOSPITAL RD 3710 SW Us Veterans Hospital PORTLAND, OR 97239 Rd # P4-0SS Portland, OR 97239 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BBFJG C 20,000 GALLONS BIODIESEL BEJAG E 25,000 GALLONS DIESEL BEJAH F 25,000 GALLONS DIESEL BGJAK G 30,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 26-46-2021-OPER FACILITY NAME AND LOCATION PERMITTEE MARQUIS CARE AT MT. TABOR April Olsen 6040 SE BELMONT ST Marquis Care at Mt Tabor PORTLAND, OR 97215 6040 SE Belmont St Portland, OR 97215 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BKHHE 3 1,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 26-61-2021-OPER FACILITY NAME AND LOCATION PERMITTEE PROVIDENCE PORTLAND MEDICAL Garth Didlick CENTER Providence Portland Medical 4805 NE GLISAN ST Center PORTLAND, OR 97213 4805 NE Glisan St Portland, OR 97213 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BGKEG 1A 30,000 GALLONS DIESEL BGKEH 2A 30,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 7-80-2021-OPER FACILITY NAME AND LOCATION PERMITTEE MILLER OIL, INC. Cheri Miller 2158 NW O NEIL HWY Miller Oil, Inc. PRINEVILLE, OR 97754 PO Box 1546 Prineville, OR 97754 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: CCGB 1 7,000 GALLONS DIESEL CCGC 2 5,000 GALLONS GASOLINE CCGD 3 10,000 GALLONS GASOLINE BGKAF 3A 10,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 31-81-2021-OPER FACILITY NAME AND LOCATION PERMITTEE ELGIN CHEVRON Jim Byrnes 8TH & ALBANY Byrnes Oil Company, Inc. ELGIN, OR 97827 PO Box 700 Pendleton, OR 97801 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: HHKF 1 10,000 GALLONS GASOLINE HHKG 2 7,000 GALLONS GASOLINE HHKH 3 6,000 GALLONS GASOLINE CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 34-86-2021-OPER FACILITY NAME AND LOCATION PERMITTEE FOREST GROVE, CITY OF - PUBLIC Ben Hiatt WORKS City of Forest Grove - Public 2551A 23RD AVE Works FOREST GROVE, OR 97116 PO Box 326 Forest Grove, OR 97116 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: AFCED 6 10,000 GALLONS GASOLINE AFCEE 7 6,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 34-105-2021-OPER FACILITY NAME AND LOCATION PERMITTEE KNEZ BUILDING MATERIAL CO. Mark Fitz 8185 SW HUNZIKER ST Star Oilco TIGARD, OR 97223 232 NE Middlefield Rd Portland, OR 97211 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BKBCJ 15-1 7,500 GALLONS GASOLINE BKBDK 15-2 4,000 GALLONS DIESEL > 20% BIODIESEL BKBDA 15-4 10,000 GALLONS BIODIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 23-106-2021-OPER FACILITY NAME AND LOCATION PERMITTEE VALLEY WIDE COOPERATIVE INC. Jeff Jones 18 N 2ND ST Valley Wide Cooperative Inc. NYSSA, OR 97913 1833 S Lincoln Ave Jerome, ID 83338 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BCEKG 1A 10,000 GALLONS GASOLINE BCEKH 2A 10,000 GALLONS DIESEL BCEKJ 3A 10,000 GALLONS DIESEL BCEAK 4A 10,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 18-111-2021-OPER FACILITY NAME AND LOCATION PERMITTEE AMA MINI MART #1 Anesti Audeh 7255 S 6TH ST AMA Mini Marts KLAMATH FALLS, OR 97603 5350 N Highway 97 Klamath Falls, OR 97601 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BDHBK 1A 10,000 GALLONS GASOLINE BDHBA 2A 10,000 GALLONS DIESEL BDHBB 3A 5,000 GALLONS GASOLINE BDHBC 4A 5,000 GALLONS GASOLINE CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 3-141-2021-OPER FACILITY NAME AND LOCATION PERMITTEE SANDY CHEVRON Ronald G. Cain 39191 PROCTOR BLVD Cain Petroleum Inc. SANDY, OR 97055 4512 SW Kelly Ave Portland, OR 97239 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BDDAE 1A 15,000 GALLONS GASOLINE BDDAF 2A 8,000 GALLONS GASOLINE BDDAG 3A 6,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 27-144-2021-OPER FACILITY NAME AND LOCATION PERMITTEE SHELL - 507 Ronald Myhro 595 MAIN ST E ARS Fresno, LLC MONMOUTH, OR 97361 2780 Gateway Rd Carlsbad, CA 92009 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BDCJJ 1A 12,000 GALLONS GASOLINE BDDKK 2A 8,000 GALLONS GASOLINE CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 10-147-2021-OPER FACILITY NAME AND LOCATION PERMITTEE MCCULLUM'S TEXACO SERVICE INC Jhana McCullum 912 SE STEPHENS ST Mccullum's Texaco Service ROSEBURG, OR 97470 912 SE Stephens St Roseburg, OR 97470 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BBAFC 173143 4,000 GALLONS DIESEL BBAFD 176210 8,000 GALLONS GASOLINE BBAFE 176213 4,000 GALLONS GASOLINE BBAFF 173142 8,000 GALLONS GASOLINE CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 24-158-2021-OPER FACILITY NAME AND LOCATION PERMITTEE MILL CITY MOBIL Robert Eastridge III 654 NW SANTIAM BLVD SAC Enterprises LLC MILL CITY, OR 97360 6341 Donaldson Rd Grants Pass, OR 97526 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BFDJJ 5 13,000 GALLONS GASOLINE BFEKK 6 4,000 GALLONS GASOLINE BFEKA 7 3,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 30-164-2021-OPER FACILITY NAME AND LOCATION PERMITTEE UMATILLA MARINA Russell W. Pelleberg 1710 QUINCY ST City of Umatilla UMATILLA, OR 97882 PO Box 130 Umatilla, OR 97882 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BCDHJ 1A 3,000 GALLONS GASOLINE BCDJK 2A 3,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 10-167-2021-OPER FACILITY NAME AND LOCATION PERMITTEE BASSETT-HYLAND ENERGY CO - CARD Scott Bassett SITE 2 Bassett-Hyland Energy 4150 OLD HWY 99S Company ROSEBURG, OR 97470 PO Box 689 Coos Bay, OR 97420 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BEJDB 1A 15,000 GALLONS DIESEL BEJDC 2A 10,000 GALLONS GASOLINE BEJDD 3A 6,000 GALLONS DIESEL CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 26-171-2021-OPER FACILITY NAME AND LOCATION PERMITTEE 7TH & ALDER CARDLOCK Wes Sherman 635 SE 7TH PetroCard, Inc. PORTLAND, OR 97214 730 Central Ave S Kent, WA 98032 TANK PERMIT: TANK ID NO: TANK SIZE: TANK CONTENTS: BEKFE 1A 12,000 GALLONS BIODIESEL BEKFF 2A 12,000 GALLONS GASOLINE BEKFG 3A 10,000 GALLONS GASOLINE BEKFH 4 10,000 GALLONS GASOLINE CERTIFICATE EXPIRES: June 30, 2022 ISSUE DATE: 06/02/2021 David L. Livengood Hazardous Waste & Tanks Manager Post this certificate where it is visible to the person delivering fuel. Rev. 20150603 CERTIFICATE TO OPERATE UNDERGROUND STORAGE TANKS REGISTRATION CERTIFICATE NUMBER 26-172-2021-OPER FACILITY NAME AND LOCATION PERMITTEE PRESCOTT CHEVRON Andy Patel 4513 NE 102ND Saphire Petro Inc.
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