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mac. �E?'Cfsa Clnlr <br /> Stale of d1liforriia FQ <br /> 5Uft Water Resctirces Control Board { <br /> CERTIFICATION CP I~INANG,IAL 13E. F�PONSIBILITY <br /> FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM <br /> A. l am required w demonstrate F-mancial Responsibility in the required amounts as specified in Section 2807,Chapter 18.Div.3,Title 23,CCR: <br /> 500,000 dollars per occurrence I million dollars annual aggregate <br /> _ or AND or <br /> 1 million dollars per occurrence 2 million dollars annual aggregate <br /> E3• STf C&-7_0A) Fi4g—1 604r" 619roiI hereby certifies that it is in compliance with the requirements of section 2807, <br /> (NameorTank0—_w s JeeratcrJ <br /> Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. I <br /> The mechanstm used to demonstrate financial responsibility as required by Section 2807 are as follows: <br /> G Mechanism Name and Address o€issuer Mechanism Coverage; Coverage Corrective Third Parti+! <br /> T. Number:, Amount Period Action . Canis <br /> A53u, ori CH Gv,�P <br /> AC P/a <br /> PnGic moo. <br /> llUsv�el u 7s'r�y Xi,4DlS0,u XUE, JVQ y � <br /> suirF /67 <br /> ,Noor`2 l N I�Ur/UA r <br /> /fObf OAA-.9, CR FS-6.251 711/9 <br /> Note: If you are using the State Fund as any part of your demorzstrition of financial r esponsibiltr,your exece.7ior,a,-,d submission <br /> of this certification also certifies that you are in com lance with all conditions for piartkiparion in the Fund. <br /> D.F&IName - Fac"Addreaa <br /> 1�7_10G,f 7-0/1) r-_4S7- tuA7-ele DIS7—HII 6767 X5. 114M) 5'i <br /> FadliryName <br /> S7oC-/r7-, C-A 95,2 iS <br /> FbcWty Addreas <br /> Fadlity Name FadGry Addr® <br /> acsl,ryN Fadliry Address <br /> MAR �- � 1�y <br /> Flaw N FadliryAddrm <br /> �i}EL TAXES VlSIOt" <br /> E. ippaeure of Ower or _ Data Name and Tittle of Tin$Owen or Operator <br /> Sigumr Dere1/ NameotMYtmesaorNc <br /> 3(/a '� 1 i Ali ' Fl/f�/ E pryC E <br /> 2} FLM Origaat–Loot Amoy Ccpim–p5dHry5ite(a) <br />