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O <br /> O <br /> rD <br /> rD <br /> n <br /> State of California LD <br /> State Water Resources Control Board For Stale Use Only . <br /> State <br /> Division of Financial Assistance N <br /> P.O.Box 944212 Q <br /> }f Sacramento,CA 94244-2121 p <br /> (Instructions on reverse side) 3 <br /> rD <br /> CERTIFICATION OF FINANCIAL RESPONSIBILITY ru <br /> ru <br /> FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM <br /> n <br /> A. 1 am required to demonstrate Financial Responsibility in the required amounts as specified in California Code of Regulations(CCR),Tite 23, <br /> Division 3,Chapter 18,Section 2807, <br /> v <br /> 3 <br /> 500,000 dollars per occurrence 1 million dollars annual aggregate �0 <br /> or AND or 0 <br /> 1 mi[lion dollars per occurrence to <br /> 2 million dollars annual aggregatev <br /> B, Ramos Oil 'o Inc <br /> hereby certifies that it is in compliance with the requirements of Section 2807, cn <br /> (Name of Tank Owner or Operator) rp <br /> California Code of Regulations, Title 23,Division 3, Chapter 98,Article 3,Section 2807. < <br /> The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: <br /> r� <br /> C. Mechanism Mechanism Coverage Coverage Corrective Third Party <br /> Type Name and Address of Issuer Number Amount Period Action Com <br /> sv• <br /> State UST Fund State UST Cleanup NIA 1,495,000 continuou Yes Yes <br /> Fund per s <br /> P.O. Box 944212 occurrence ru <br /> Sacramento CA 94244 and annualrD <br /> rD <br /> 1 Chief Finacial Ramos Oil Inc NIA 5,000 per Annual Yes Yes <br /> Officer Letter P.O. Box 401 occurrence ° <br /> W Sacramento, CA and annual °, <br /> 95691 aggregate < <br /> m <br /> Note: < <br /> rD <br /> n <br /> O <br /> 3 <br /> Note: if you are using the State Fund as any part of your demonstration of financial responsibility,your execution and submission of 3 <br /> this certification also certifies that you are in compliance and shall maintain compliance with all conditions for participation in the F, <br /> Fund. See instructions. <br /> N <br /> Facility Address \ <br /> N <br /> D. Facility Name <br /> Ramos Oil Co, Inc 10842 S Harlan Rd French Camp, CA 95231 N <br /> Facility Address <br /> Facility Name <br /> Ramos Oil Cot Inc <br /> Facility Address <br /> Facility Name <br /> Ramos Oil Co, Inc <br /> E. <br /> Date Name and Title of Tank Owner or Operator <br /> Signature of Tank Owner or Operator <br /> ro/s/ 0,7-0 rW Kent Ramos, CEO <br /> Signture of Witness or NotaryDafe me of Witness or Notary <br /> ,�� ro/s/Zoe uren Takos, EHS Manager <br />