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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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WALNUT GROVE
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2900 - Site Mitigation Program
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PR0506456
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
6/22/2020 7:56:02 AM
Creation date
6/22/2020 7:47:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0506456
PE
2950
FACILITY_ID
FA0007437
FACILITY_NAME
M & K GAS STATION
STREET_NUMBER
8960
Direction
W
STREET_NAME
WALNUT GROVE
STREET_TYPE
RD
City
THORNTON
Zip
95686
APN
00115029
CURRENT_STATUS
02
SITE_LOCATION
8960 W WALNUT GROVE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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�i <br /> EXHIBIT A <br /> - 11 <br /> For stat the Onh <br /> Slate of California <br /> _ State water Resources Control Boarder <br /> c. Division of Clean Water,Programs ' w.!._ {�► '! ; II <br /> P.O.Box 944212 t `l <br /> Sacramento,CA 94244-2320 (Instructions on rmrse) <br /> CERTIFICATION OF FINANCIAL RESPONSIBILITY <br /> FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM <br /> A. I am required to demonstrate Financial Responsibility in the required amountsas spxified in Section 2807,Chapter 18,Div.3,Tift 23.CCR: <br /> I i a 500,000 dollars per occurrence FRA 1 million dollars annual aggregate <br /> ! or • AND or <br /> =I million dollars per occurrence a2 million dollars annual aggregate I; <br /> t <br /> SUNNYSIDE PRODUCE hereby certifies that it is in compliance with the requirements of Section 2807, <br /> Acme of Twk akin.w Opmrw) I) . <br /> t j Article 3, Chapter 18, Division 3. Title 23,Califomia Code of Regulations. <br /> The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as folk"s..- <br /> IC. Mechanism Name and Address of Issuer' Mecharnsrti Coverage Coverage :"Cbrrective ;Thud Patty; <br /> Artttiunt; Period;:; AcLton ;,,�Com <br /> R <br /> E STATE UST FUND $995, 006 . STAT <br /> STATE P.O. Box 944212 <br /> per ` UST YES � NO <br /> FUND Sacramento, CA I N/A occuran e CONT. <br /> 94244-2120 ] Annual <br /> ggregate <br /> ' CHIEF SUNNYSIDE PRODUCE N/A $5000 .00 <br /> IFINANCIAL P.O. Box 700 per I <br /> ` ' OFFICER Thornton, CA 9568 occuranceAnnual Yes NO <br /> Annual <br /> I i <br /> Aggregate <br /> i <br /> Note: If you are using the State Fund as any part of your demonstration of financial responsibility,your execution and submission <br /> of this certification also certifies that you are in cot fiance with all conditions for par6cipation in the Fund <br /> Farilitr Name FeokW AddrM II <br /> SL PRODUCE g60 <br /> i <br /> hornWtonWaaut Grove Rload I <br /> = aN,n'Name FawiFy Addrep i <br /> I <br /> Fenlen Name '�' FaCdi3F Add-ea <br /> P <br /> _ I i <br /> I <br /> ! F—bw Meme Fa ty Address <br /> i I <br /> i Si�uue ofT-k.0—*"Ppaaw ome Nems end Tide orT Ow r0v� <br /> I <br /> f <br /> L <br /> i Siytaiwe Wit•ess o,'aan� Date Nameof Wi Haar ;i f <br /> 01� <br /> Of NIARLA A. NAHOFN <br /> CFWRcrisad ry 1 FELE: Original-Local Agency Copies-Facility/Site(s) <br /> E . DOUGLAS n^ANSER / MARY ANN MANSER �� Page 26 <br /> co <br /> Py <br /> a � <br />
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