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w <r <br /> § 18245 California Integrated Waste Management Board Title 14 <br /> state of califomia California integrated Waste Management Board <br /> CERTIFICATE OF SELF-INSURANCE AND RISK MANAGEMENT <br /> of additional space is needed,add attachment.) <br /> Operator Address <br /> San Joaquin County 1810 E.Hazelton Ave.,Stockton,CA 95205 <br /> Risk Manager Address(if different from above) <br /> Canlis Building,Room 106 <br /> Richard Pietz 24 S.Hunter St.,Stockton,CA 95202 <br /> Solid Waste Disposal Facilities Covered: (Enter Information For Each Facility) LIABILITY <br /> OF <br /> Facility Per Annual <br /> Name Address Information Occurrence" Aggregate' <br /> Number <br /> North County 17900 E.Harney Lane <br /> Recycling Center Lodi,CA 39-AA-0022 $1,000,000 $1,000,000 <br /> &Sanitary Landfill <br /> Corral Hollow 31130 S.Corral Hollow Rd. 39-AA-005 $ 1,000,000 $ 1,000,000 <br /> Sanitary Landfill Tracy,CA <br /> Foothill Sanitary 6484 N.Waverly Rd. 39-AA-0004 $1,000,000 $ 1,000,000 <br /> Landfill Linden,CA <br /> Harney Lane 14750 E.Hamey Lane 39-AA-0003 $ 1,000,000 $ 1,000,000 <br /> Sanitary Landfill Lodi,CA <br /> TOTAL: TOTAL: <br /> $4,000,000 $4,000,000 <br /> °Excluding legal defense costs <br /> CERTIF[CATION: <br /> 1. The operator and risk manager named above hereby certify that the facilities listed above are self-insured for <br /> third party bodily injury and property damage in connection with the operator's obligation to demonstrate <br /> financial responsibility under Title 14,California Code of Regulations,Division 7,Chapter 5,Article 3.3. <br /> The coverage applies to the above-listed facility(ies)for accidental occurrences arising from the operations <br /> of the facility(les). <br /> 2. The limits of liability are the amounts stated above for"per occurrence"and"annual aggregate",exclusive of <br /> legal defense costs.. <br /> 3. Indicate whether this coverage is--primary or--excess coverage. <br /> �p <br /> 4. Upon request by the Board,the operator agrees to furnish to the Board any documents pertinent to this <br /> coverage. <br /> 5. Termination of this coverage,will be effective only upon written notice,sent by certified mail,and only after <br /> the expiration of 60 days after a copy of such written notice is received by the Board and the local <br /> enforcement agency for the jurisdiction in which the facility is located,as evidenced by the return receipts. <br />