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COMPLIANCE INFO 2003 - 2008
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2300 - Underground Storage Tank Program
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PR0231706
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COMPLIANCE INFO 2003 - 2008
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Last modified
6/11/2019 11:42:03 AM
Creation date
4/10/2019 2:41:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2003 - 2008
RECORD_ID
PR0231706
PE
2361
FACILITY_ID
FA0000485
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95242
APN
05532024
CURRENT_STATUS
01
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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KBlackwell
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EHD - Public
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EXHIBIT B <br /> OTE: Effective July 1, 1995, California Small Businesses and California Businesses with 500 <br /> employees or less must demonstrate at least $5,000, exclusive of the UST Cleanup Fund, <br /> businesses with over 500 employees must demonstrate at least$10,000. (Chap. 6.75 H&SC, <br /> Sect. 25299.32) <br /> The Chief Financial Officer or the owner or operator must sign, under penalty of perjury, a letter worded <br /> EXACTLY as follows or you may complete this letter by filling in the blanks with appropriate information: <br /> LETTER FROM CHIEF FINANCIAL OFFICER <br /> I am the Chie cial Officer for MAKE BELIEVE CO., 123 TANK STREET, <br /> (Business name,business address,and correspondence address of owner or operator) <br /> FUND CITY,CA 90001, P. O. BOX 100,FUND CITY,CA 90001 <br /> This letter is in support of the use of the Underground Storage Tank Cleanup Fund to demonstrate <br /> financial responsibility for taking corrective action and/or compensating third parties for bodily <br /> injury and property damage caused by an unauthorized release of petroleum in the amount of at least <br /> $ 5,000 per occurrence and $ 5,000 annual aggregate coverage. <br /> (Dollar Amount) (Dollar Amount) <br /> Underground storage tanks at the following facilities are assured by this letter: <br /> MAKE BELIEVE CO.,STATION#1, 123 TANK ST., FUND CITY,CA 90001 and <br /> (Name and address of each facility for which financial respium=Lity is being demonstrated.) <br /> MAKE BELIEVE CO. STATION#2 789 SITEWVM FUND CITY CA 90002 <br /> 1. Amount of annual aggregate cover being assured <br /> bythis letter......................................................................... $ 5,000 <br /> 2. Total tangible assets.............................................................. $ (Asset Figures) <br /> 3. Total liabilities....................................................................... $ (Liability Figures) <br /> 4. Tangible net worth(subtract line 3 from line 2. <br /> Line 4 must be at least 10 times line 1)................J. .... $ (Net worth Figures) <br /> I hereby certify that the wording of this letter is identical to the wording specified in subsection 2808.1(d)(1), <br /> Chapter 18, Division 3, Title 23 of the California Code of Regulations. <br /> r penalty of that the foregoing is true and correct to the aT of m knowledge and <br /> I declare unde p y perJury g g y g <br /> belief. <br /> Executed at FUND CITY, CA <br /> (Place of Execution) <br /> On JULY 3. 1995 <br /> (Date) <br /> P 1��J <br /> (Signature) <br /> RHEA CYCLE <br /> (Printed Name) <br /> OWNER <br /> (Title) <br /> UST 02FR revised 4/95 <br />
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