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Home My WebLink About1131 OAK STREET (4)State of California For State Use Only State Water Resources Control Board Division of Financial Assistance P.O. Box 944212 Sacramento, CA 94244 -2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the required amounts as specified in CCR, Title 23 Division 3, Chapter 18, Section 2807: 500,000 dollars per occurrence 1 million dollars annual aggregate or AND or 1 million dollars per occurrence ® 2 million dollars annual aggregate hereby certifies that it is in compliance with the requirements of California Code ofB. Chevron U.S.A. Inc. Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807. Name ofmokOwner orOperator) The mechanisms used to demonstrate financial sponsibility as required by Section 2807 are as follows: C. Mechanism Name and Address of Issuer Mechanism Coverage Coverage , Corrective Third Party Type Number Amount Period Action Compensation Chevron U.S.A. Inc. CFO/ Attn: Permit Desk 1 Million / 4/27/2011 toN/A Yes YesFinancialTest6001BollingerCanyonRd2Million4/30/2012 San Ramon, CA 94583 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission ofthis certification also certifies that you are in compliance and shall remain in compliance with all conditions for participation in the Fund. D Facility Namc FacilityAddress Chevron Station# 98109 1131 OAK ST, BAKERSFIELD, CA 93304 Fanlay Namc FacilityAddress Facility Name FacilityAddress FacilityName FacilityAddress Facility Namc FacilityAddress FacilityName FaciliyAddress FacilityName FacilityAddress signature ofTankOwncr or Operator Dam Name and TitleofTankOwner orOperator 04/27/2011 Charles Bittle / Chevron Compliance Specialist Ignatmcat nnessor Notary Date Name of Witness or Notary 04/27/2011 Linda Justus / Chevron Permit Desk Submit original to local UST regulatory agency. Keep a copy at each UST facility. UN -049 - 1/500 www.unidocs.org Rev. 10/16/06 State of California For State Use Only State Water Resources Control Board Division of Financial Assistance P.O. Box 944212s Sacramento, CA 94244 -2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. 1 am required to demonstrate Financial Responsibility in the required amounts as specified in CCR, Title 23 Division 3, Chapter 18, Section 2807: 500,000 dollars per occurrence 1 million dollars annual aggregate or AND or 1 million dollars per occurrence ® 2 million dollars annual aggregate hereby certifies that it is in compliance with the requirements ofCalifornia Code ofB. Chevron U.S.A. Inc. Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807. Nameoftank Owneror Opemror) The mechanisms used to demonstrate financial sponsibility as required by Section 2807 are as follows: C. Mechanism Name and Address ofIssuer Mechanism Coverage Coverage Corrective Third Party Type Number Amount Period Action Compensation Chevron U.S.A. Inc. CFO/ Attn: Permit Desk 1 Million / 4/27/2011 to Financial Test 6001 Bollinger Canyon Rd N/ 2 Million 4/30/2012 Yes Yes San Ramon, CA 94583 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission ofthis certification also certifies that you are in compliance and shall remain in compliance with all conditions for participation in the Fund. D Facility Name Facility Address Chevron Station# 201527 6601 MING AVE, BAKERSFIELD, CA 93309 Facility Na Facility Address Facility Nam. Fmhly Address Facility Namc Facility Address Facility Na- Facility Address Fecdity Na— Facility Address Facility Namc FacilityAddress Sigtutmc ofTank owneror Opcmtor Dat. Namc wid TLdc ofTank OwnerorOpemtor 04/27/2011 Charles Bittle / Chevron Compliance Specialist tgnumrc of Woos orNoLtn Date Namc ofWitness or Notary N•a, `° 04/27/2011 Linda Justus / Chevron Permit Desk Submit original to local UST regulatory agency. Keep a copy at each UST facility. UN -049- 1 /500 www.unidoes.org Rev. 10/16/06 State ofCalifornia For State Use Only State Water Resources Control Board Division of Financial Assistance P.O. Box 944212 Sacramento, CA 94244 -2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the required amounts as specified in CCR, Title 23 Division 3, Chapter 18, Section 2807: 500,000 dollars per occurrence 1 million dollars annual aggregate or AND or 1 million dollars per occurrence ® 2 million dollars annual aggregate hereby certifies that it is in compliance with the requirements of California Code ofB. Chevron U.S.A. Inc. Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807. Nameoftank Owneror Operator) The mechanisms used to demonstrate financial sponsibility as required by Section 2807 are as follows: C. Mechanism Name and Address ofIssuer Mechanism Coverage Coverage Corrective Third Party Type Number Amount Period Action Compensation Chevron U.S.A. Inc. CFO/ Attn: Permit Desk 1 Million/ 4/27/2011 toN/A Yes YesFinancialTest6001BollingerCanyonRd2Million4/30/2012 San Ramon, CA 94583 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance and shall remain in compliance with all conditions for participation in the Fund. D Facility Name FacilityAdd— Chevron Station# 203576 1125 COFFEE RD, BAKERSFIELD, CA 93308 Facility Name FacilityAddress Facility Name FacilityAdd.. Faacility Namc FacilityAddress FacilityName FaeilityAddress FatalayName FacilityAddress Facility Name FacilityAdd — SigoalumofTankOwnerorOperator Date Name andTitle ofTank Owner orOperator 04/27/2011 Charles Bittle / Chevron Compliance Specialist ignalurco uncssor omq Date Name of Witness or Namv 04/27/2011 Linda Justus / Chevron Permit Desk Submit original to local UST regulatory agency. Keep a copy at each UST facility. UN -049 - 1 /500 www.unidoes.org Rev. 10/16/06 State ofCalifornia For State Use Only State Water Resources Control Board Division of Financial Assistance o P.O. Box 944212 Sacramento, CA 94244 -2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the required amounts as specified in CCR, Tide 23 Division 3, Chapter 18, Section 2807: 500,000 dollars per occurrence 1 million dollars annual aggregate or AND or 1 million dollars per occurrence ® 2 million dollars annual aggregate hereby certifies that it is in compliance with the requirements ofCalifornia Code ofB. Chevron U.S.A. Inc. Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807. Name oftank OwnerorOperator) The mechanisms used to demonstrate financial sponsibility as required by Section 2807 are as follows: C. Mechanism Name and Address of Issuer Mechanism Coverage Coverage Corrective Third Party Type I Number Amount Period Action Compensation Chevron U.S.A. Inc. CFO/ Attn: Permit Desk 1 Million / 4/27/2011 to Financial Test 6001 Bollinger Canyon Rd N/A 2 Million 4/30/2012 Yes Yes San Ramon, CA 94583 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance and shall remain in compliance with all conditions for participation in the Fund. D Facility Name Facility Address Chevron Station# 206561 3360 PANAMA LN, BAKERSFIELD, CA 93313 Faeduy Name Facility Address Facility Nam Facilitv Address Facilitv Name Facility Address Facility, Name Facdity Addrw Facility Nam Facility Address Facility Name Faality Address SigmaurcofTank Owner oroperator Date Name andTitle ofTank Oxner oroperator 04/27/2011 Charles Bittle / Chevron Compliance Specialist rgna toreo imess or oran' Date Name of Witness or Notary 04/27/2011 Linda Justus / Chevron Permit Desk Submit original to local UST regulatory agency. Keep a copy at each UST facility. UN -049 - 1/500 www.unidocs.org Rev. 10/16/06 State ofCalifornia For State Use Only State Water Resources Control Board Division of Financial Assistance P.O. Box 944212e: Sacramento, CA 94244 -2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the required amounts as specified in CCR, Title 23 Division 3, Chapter 18, Section 2807: 500,000 dollars per occurrence 1 million dollars annual aggregate or AND or 1 million dollars per occurrence ® 2 million dollars annual aggregate hereby certifies that it is in compliance with the requirements ofCalifomia Code ofB. Chevron U.S.A. Inc. Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807. Nameof lank Owneror Operator) The mechanisms used to demonstrate financial sponsibility as required by Section 2807 are as follows: C. Mechanism Name and Address ofIssuer Mechanism Coverage Coverage Corrective Third Party Type Number Amount Period Action Compensation Chevron U.S.A. Inc. CFO/ Attn: Permit Desk 1 Million/ 4/27/2011 toN/ Yes YesFinancialTest6001BollingerCanyonRd2Million4/30/2012 San Ramon, CA 94583 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance and shall remain in compliance with all conditions for participation in the Fund. D Facility Namc FacilityAddress Chevron Station# 355920 10 UNION AVENUE, BAKERSFIELD, CA 93307 F cililyNam FacilityAddress FacilityName FacilityAddress FacilityName FacilityAdd — FacilityName FacilityAddress FacilityName F,xilityAddress FacilityName FacilityAddress Sigmame ofTarkOwneror Operator Date Name and TitleofTankOwnerorOperator 04/27/2011 Charles Bittle / Chevron Compliance Specialist agnaturc o nnessor Notary Date Nameof Witness or Notar) 04/27/2011 Linda Justus / Chevron Permit Desk Submit original to local UST regulatory agency. Keep a copy at each UST facility. UN -049 - 1/500 www.unidoes.org Rev. 10/16/06 List of Chevron Owned Locations for 2011/2012 UST Financial Responsibility City of Bakersfield Fire Dept. Prevention Services Chevron Station# 98109 1131 OAK ST Chevron Station# 201527 6601 MING AVE Chevron Station# 203576 1125 COFFEE RD Chevron Station# 206561 3360 PANAMA LN Chevron Station# 355920 10 UNION AVENUE BAKERSFIELD CA 93304 BAKERSFIELD CA 93309 BAKERSFIELD CA 93308 BAKERSFIELD CA 93313 BAKERSFIELD CA 93307