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5'tdtc ofCulit'0rnia For•sta6,use Only <br /> 8tutc of Afaler Resources.ewontrnl Board <br /> Division or Muhncial ass siatice <br /> 8qx,944212 <br /> $neramente,CA 94244-2120 <br /> {Instrucriais.tm rCVCrseslde). <br /> CERTIFICATION OF FINANCIAL RES.POWSIBILITY <br /> 00R t1NDLRGR().'QN.11 5T6RAGE'TANKS CONTAM NG PETROLEUM <br /> A_ C ata ragUiiul tR dentonstrale Financial itcs onsiiiility`in tltc"it+.gEtircd•amounts 7ecilfed in$Getiop:2x07,C�taptcr[$,Div.3,111kt'23;CCIt:• <br /> 500,(1()0 dollars.per 0c41Jrren4za Imillion dollars-onnuQ]aggNgan;.• <br /> or AND or,. <br /> 1.Ini1lion d'o[ars per,ot currettE ❑ 2 million dblinrs aniival.aggrggate~ <br /> B: f p hemby certifies thatirisjn compliance wi{h-the''requirements of.-Secdan 2807, <br /> ill ome3 of ink owner-ar op0tarl <br /> Article 3, Chapter 18,Dl Von 3;.77t1d 23; Galiforltia Code of Re_�uWot?& <br /> The mechanisms used to de'Monstiate:fchaircfa!{espondbjY4r0s•regcjlred by Section 260Tare as frilfdWs: <br /> • Mecrift€sm Alfechariisrn. Coverage. Coverage. .Garree6ve, Third"Party <br /> T 'e Name and:Address cfissuer- Nurnb& Ahiount~ Period Action 'Camp <br /> Illinois Union,I.nsurance. <br /> Gompant (0/o CHUBB $toda.000 <br /> CaisirneFaal Erlvironn'ental Risk.P.O.Box I PPI 628.117565 7/112022— Yes. y6s <br /> Insurance 100%-436-Walnut.Street' 003- 711/2025 <br /> WA07A,Philadelphia, RA <br /> Note: Ifytiu awusft the State Fund as any part of your damonstr6fion of rriancial respapsibifity,yow igxecuffon anq submission of <br /> (tris certification b1;sa:certi)Tes;that.ybu•are'ih.co'npfiahce wr`th aft conditions fiorparticipbM&n in=the Fund. <br /> M Facility Wafne I;acho Address <br /> �I.7rx <br /> SV r'7► i!.r' li+,n�-r i�S k,-.e �!A- `FS 3-7 !- <br /> ,Facility Name •Facility Address <br /> 17961ty Idartsa Facility Address <br /> I='. 5[gnafure of Tank[7wraer or Qperator bate 'Mami�•and Title-ofTanik"Owner or Operator <br /> ll ih& <br /> 'S&'Mu' draess or Notary Date 'lame of Wines s or.N try <br /> CE'I�(Kevise Q9leJ5J FIi.E: Qri�ii+al-Law7E-t4g;crscti' Con?es=I�ncElitylSi4e(9} <br />