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COMPLIANCE INFO_2007-2013
Environmental Health - Public
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EHD Program Facility Records by Street Name
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T
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TRACY
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2300 - Underground Storage Tank Program
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PR0508090
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COMPLIANCE INFO_2007-2013
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Last modified
11/29/2023 9:01:09 AM
Creation date
6/23/2020 6:58:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2007-2013
RECORD_ID
PR0508090
PE
2361
FACILITY_ID
FA0007938
FACILITY_NAME
CHEVRON #208117**
STREET_NUMBER
755
Direction
S
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95376
APN
24202029
CURRENT_STATUS
01
SITE_LOCATION
755 S TRACY BLVD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0508090_755 S TRACY_2007-2013.tif
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EHD - Public
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AC RD CERTIFICATE F LIABILITY INSURA . OP C1 DATE(MMIDDIYYYY) <br />SERVI01 06 03 08 <br />George <br />THISZERTIFICATE SUED AS AMATTER 'OF INFORMAM0N <br />Georg® Petersen Isis Agency ONLYANO CONFEfi&.3 AIGHT-S'UPbN TMEICERTIFJCATE <br />P. 0. Box 3539 HOLDER Tii18"CER'fIFICATE:DOES-NOT AMEND fXTEND`OR <br />627 College Avenue ALTER-TNE CO.YERAGEAFFORDED'8Y THE P.OUCIES BELOW. <br />Santa Rosa CA 95402 <br />Phone: 707-525-4150 - Fax:707-525-4175 1NSLIRERSAFFORDING:COVERAGE NAIL# <br />INSURED INSURER A -- <br />reas.• Insurance an <br />INSUREAM:t <br />S rvi.cg Station Systems, Inc. INSURE&C: <br />680 inn Avenue <br />San Jose CA 95112 <br />INSURER:E: <br />mvpRAngs <br />THE POLICIES OF INSURANCE LISTEDsELOW HAVE BEEN ISSUED'TO THE INSURED NAMED ABOVEFOR IjDL4CYTERIODYNDICAT.EDi NOTWnMT-ANDING <br />ANY REQUIREMENT; TERM OR CONDIVONOF ANY CONTRACT ORDTHER:DOCIiMENT <br />WITH RESPEC7<To�WHIC4i'°iit$iCfRMFICATE MAYSEISSUEDDR <br />MAY PERTAIN,^THE INSURANCE AFFORDED BYTHE POUCIES:DESCRISEGAIEREIN IS SUBJECT TO ALLTME TERMS;EXCLUSIONS-AND CONOITJONS �F SUCH <br />POLICIES. AGGREGATE'LIMITSSHOWN MAYHAVE BEEN REDUCED BY PAID`CLAIMS. <br />LTR <br />Amn <br />NSR <br />- TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE . <br />iD <br />MRA <br />DAM' DDA Y " <br />UMITS <br />GENERAL :ijA ILITY <br />COMMERCIAL GENERAL LIABILITY TY <br />EACHXaCOURRENGE; i <br />S <br />S <br />CLAIMS MADE a OCCUR <br />PE, 1iDNALIA ADV4NNURY • S ^ <br />GEt�SRAGAGGREGATE'. S <br />BERL AGGREGATE LIMIT APPLIES PER:PROEttlFTS=COIF±%OP,AGG <br />POLICY JEC LOC <br />S <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />{Ew eccWenq <br />ALL OWNED AUTOSBODIL <br />-- <br />TO <br />SCHEDULED AUS <br />JURY <br />(Perm UI) S <br />(Por parocn <br />HIRED AUTOS <br />NDN -OWNED AUTOS <br />BODILY INJURY S <br />(Per oxidanl) <br />PROPERTY DAMAGE S <br />(Per acro!) <br />GARAGE UABILITY <br />AUTb ONLY - EA ACCIDENT i <br />ANY AUTO <br />OTHER THAN EA ACC S <br />AUTO ONLY: ADG S <br />EXCESSIUMBRELLA LIABILITY <br />OCCUR ®CLAIMS MADE <br />EACH OCCURRENCE $ <br />AGGREGATE S <br />s <br />DEDUCTIBLE <br />S <br />RETENTION S <br />s <br />A <br />WORKER ON AND <br />EMPIjDY-ERNa^i1A8SM7Y <br />ANYPROPR6YORf ARTNERIEXECUTIVE <br />OFRICERAAE�BFR•EXCLVDED7 <br />ROVISIO NS lmlow <br />SPECIAL PROVISIONS <br />OTHER <br />3310020636081 <br />06/44/08 <br />06/04/09 <br />I <br />R TRY I S R <br />EL EAC.* 610FMT S,1000,0100 <br />ElDISEASE,.EA MMLOY.EE:S344Od�00 <br />ELOISFASE:+'POUCYLTMIT* 3 10000 <br />DESCRIPTION OFOPERATKNIS I LOCATIDtM i VEHICLES d EXCLUSIONS°ADDEDMYLNDORSEMBNT1'SPECIAIGPROVISIONS"' <br />Re: License #485184 <br />Evidence of workers' Colopensation Coverage. <br />Ten Day Notice of Cancellation in the event of non-payment of -.premium. <br />Contractors State License Boar <br />PO Box 26000 <br />Sacramento CA 95826 <br />ACORD 26 (2001/08) <br />SHOULD.AN""HEAHOVE DESCRiBEDPOUCIES BE CANCELtEDEEFORETHE-EXPIRA'nON <br />DATE'THEREOFiTWISSUIVO`INSURER-MLLENOBAVOR TOmAIL 30* ' DAYS WRITTEN <br />NOTK:E=ZHECERTIRCATEIiOLDER tIAMEb TOTHE LEFT, BUT FAILURE"TOD080 SHALL <br />IMP03EE*0011RWOATION OR,LIABILtTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />9RR <br />
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