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Home My WebLink AboutBUSINESS PLAN 12/17/2004 11:50 602-728-5214 6èc ~6 .2004 11:26 FR RIG ENVIRONMENTAL , TMC SERVICE 213 689 391~ TO 91B47S532691 PAGE 02 p.0a r NoAMi!: ADDRESS: C!RTIFICATE OF INSURANCE SEE SCHEDULE BELOW SEE SCHEDULE BELOW 't'~'~ _..... POLICY NUMBER: ENDORSI!MENT: . . 8T808B.1)8& [P@@OO @[ÆR@O[;{]&fb pe~too' OF. COVERAGE: NAME OF ~NSURER: . COMPANY ADDRESS OF-1NSURER: . i i i I ¡ I , I AMERICAN INTERNATIONAL $P~ÇfA'= TV ~'NES INSURANCE I I ! .-.:t:.~... _<4.";;"-" ,;;;:;:::'7"':-":':' . . ~- "" "'. , Not appllcabl8 12/17/04 - 12/17/015 10 PINE STR~ET NEW YORK, NV 10270 NAMe OF INSURED: ADDRESS OF INSURED: . Circle ( S10re8, In", 1 !500 N. Priest Dr. Tempi, I'Z 86281 CERTIFICATION: 1. AMI;RICAN INTERNATIONAL SPECIALTY LINES INSURANCE COMP~Y, the Insurer, '8S· jd.n~ifilid ebove/ hereby Certifies that It has;ls8lJod liability InaursnC$ còv~'ing the followfng .. . underground storagø tank(s): ¡ ¡ ¡ See. ·'tøm 5. Covered Storl"g' T,nkSYtttamC.)· on policy ntforon~ød abovo, , ! . . . . . i for taking. corrective 8ctlon. Ind eOmpø"1J8t1~g trtlrd parties for bodily injur~ and property damage caused by Dccide~tall'ÐrøillSe8 in 8cc~rdanc. with and SUb8Ct to the limn. of "'billW, lur(:lusion., conditions and other term. Of. thep~iicy.ri*ing from operating the undBr~rQund storage tank Is) idantifiød above. 1· i The limits of liability afe," .000,000 eaçh ~currence and $2,000,000 a~nuaJ aggregete, exclusive of liJg~1 defense costs,· which are subJeot 10: I ..perfl1. limit under the POI~CY. Thie co"et"9~·iø provIded under STB089599, . The effective ,dl~e of Bald policy I. Dec"m~ar 17, 2004. .. , 2. The Jn~urÐ¡' further øo~ltl8ø the fallowing with respeøt to the insurancJ described in Parag,raph 1: . . .. I·. . .' . . i. a. Bankruptcy or insolvency of th,,:lnsured shell not rellev. the 1~ll)rer of It" obligations' . " I under the policy to whic,", this 'cenlflc8tØ applies. ! , ,. '. . I· b. . The .In'surer Is. liable før tha payment of "mo"'"t' withih any d~duciiÞl8 applioab.. to t"o . policy to the provider of corrective action or dameoed third p~y, with . right of . i· reimbursement by the insurêd for .lIny such paYmønt made by·~he Insurer. This. provision doès, not apply with resper:t to that .f1mQum of esny deduc.tible Ifor whh.h covera9~ i. i . CI~C)6' . . 12/17/2004 11:50 602-728-5214 .. pEC 16 2004 1'1:26 FR RIG ~NUI~ONMENTRL .' TMC SERVICE 213 689 3918\ TO 918479532891 i , ! I I . . . I c:I.møn~1tr8titd under anotber mschanlsm or oombinatign of m~hBnlsms a8 ·speclfled in ·40 CFA280.96-280.102. ! I , c.. whenever requested by a, Director of an IrrUJlemonting agency~ the Insurer agrees to ,. ¡ furnl." 10 the Director a signed duplicate original of ,ho polioyi Bnd all endorsemènts. . i .. d. CancellatiOn or anY. othor termlnatJòr\ of tha insurançe by the ~urer, except for "on~ ' peyment of premium or ~isrepresent8tlQn by the "'"ured. will Ibe effective oniy upon . ". I . wrltt1tn notice and on,ly after the expiration of 60 days efter e ¡eopy of auc:h writt~n . . ' '.' ¡ "notlc,e Is recelvedbv th.,i~8ured. c.ncallation for non~payme~t of premium or . I· . misrepresentatlof) by the In'lJted wili be effective only upon ~ritt8n notice and on.ly . .' . , I after expiration of II mln'mum Of 10 deYI .fter . copy of such: written notice is foceived . I . , by 'the Insured.· ¡ ì 6. The. iniùr¡¡nCBCOVers claims otherwise covered by the policylmat .re reported to the Insurer wIthin six month. of the øff.Gtivo date of cancellationor non-renewal of the' policy except where the new or renewed øolley h!ll tho .eme !røtrotetiVØ date or II , , ' ,cnroaotl". dete Burtisr than that of the prior polley, and Whlct) aris8 out of any covered occurrence tnat comm.nceda'fter th. pOlicy retroactive date, ¡if .pplicabl~. and ørior tô sU(ih policy renewal· or ter.mlnatlon date. Claim. ,.potted dUrl~9 al,lch eJrtClnd.d .. I roportlng perJad .ni,ubjecuD thø terms. conditions. limits. irl,cludln9 limits of liability; . I· and exclusions of ~hepollcy_ i i I horoby certifY that the wordIng ofthia inøtrument is identical to ~B wgrdìn9 in 40 CFR . . . . . . ¡' 280.97. (b) (2) and that the Insurer Is eligible to provide Insuranc,l el an 8,XO." or surplus . . . : ""e. In.uror in gne or more· states. ! ~2\-\-\\.4 . , .SJgnatute of Authoriz~d Repfesen~atlvtt of Insurer Pevidl'averkamp Regionul Manager. .. Authòr!zed .Reþresentatlve of Amerlcln Intemltiøn.I Specialty Linþ& In8wrcin~ Company· 777 South Figueroa Street. 18m Floor, Loa Anø.I.., CA 90017 ! . -~"'-'~'4.. ~~"__::' ~@@œ @œD®O~£[L - . " . CI2567 2 PAGE 03 , p.es .. l' Circle K Stores Inc. . Certificate of Financial Responsiblity Site List 12/17/04 through 12/17/05 2549 BLOSSOM ............--.......--...........................- 2549 BLOSSOM .. ....mm.._..._......................__..... 1021 SHAFFER RD ..... ...........................................-.-....--.-.---.. 1021 SHAFFER RD ......m..........__...................... AFFER RD ...................................................... MAIN ST 40 N MAIN ST .-.-..-...............-......--..........-.............-..... i 40 N MAIN ST t _··..·············_··_·.··.·.._._.____m_.__._. l?!05439 1240 N MAIN ST l?7'º.~~?.m___ ~~~~A~Ÿ'Ïf.B.º~~g·.ª! \2705432 899 HAWTHORNE ST y...................................--......--. ...............................-..............-.............................. \2705432 899 HAWTHORNE ST ;.._.........__ ....m.._........._............... ......m...................__..._......___............... l?7'º~~?mmmm~~!3._f:!~~f:!º_~f\~ST L?!º?!~?____. ..?7'~ª~~Iºt-.lF'~'J\I'(_mmm._____ ¡?!Q?!86 ?!~~~Iºf'.'."~1JVY )2700337 10597 JURUPA RD ~..._.._..__......_......_-_._-......__. ............-.....-......................--..-.... :2700337 URUPA RD [??-º§.~~~~::=== . CLlÑTOÑ~T:-__.__._._... . 38 43955 CLINTON ST .....--. ..................-..-..-..........................-..-....- 564 73010 RAMON RD 1178 ..-...-............-......-....- 78 19 19 2705221 2705221 12705221 l......·......··....·......·.. ! 2!º~?~q. :2705230 ¡....-.....-....... l?!º?230 !?!º?6~~.. l?705659 l?!º5.I55.~. !2703614 r:1703614 [~?03614· 12703621 ¡...... ..............-.............._..... I?!ºª??!-·- 12703621 .. ..........-......-............ 2705017 2705017 2705017 ........................................-- 2705018 2705018 .....................-........................_.... 2705018 ,2705439 i27Õ5439---··· .................................-.... .......1.~9!I5J~éJ~E!~~E!I~..~!t:E!..ºE!PéJr:!f!lE!':1t... 11~~~IBakersfield '::it:E! Departmentmmmmmmm. 9816\ Bakersfie1d Fire Department ~ªj~r~~~~~f¡~IªË¡~~þ~é~áiri~Òt .............. .................... 9816\Bakersfield Fire Department ~ª1~¡~?~~r.~f¡~Iª~¡r~þ~é~~iri~~tmmmmm.__m Bakersfield Fire Department 9à1··6'tï3'a-k;~iiei(j"··Fï~e··Depa·rt~ëñi··-··· .. .............._....-........-...... ...~~1~Œ~k~r~f¡~ïëï}¡!~þ~P?áiri~~i.. 9816!Bakersfield Fire Department ~~1~r~~k~ïjfi~ï~-fi~~º~p~~ii1~riL_ . ..... .......m_..m_.. 14976 Fresno Co. Env..!:Ieal!~...~.¥.~temmmmm_._ . !:IE!.éJlt~~Y~!E!f!I_ m mm.....m....._():..~_':1"..:..f.:I.E!éJlt_~§.y~!E!f!I . .~.~1I5ty~E!~':1()ç()·..~':1,,:!:IE!éJlt~§.Y~!E!f!I 98161 Fresno Co. Env. Health System ·..·..·..·..·.....98·1t3TFreSno·-Co~n·Eñv·:·..~i~alth·..8'~!~~~...~~~~~~~......~~~~~~~~~~~~~~~.~~.~...~ o Co. Env. Health System ·::-_~~j~tfr.~~~~ç~:~~y::~~~liii:~i~i~~:_ 96841 Imperial County Health Department .-..'m.mmB~~ïiri:þ~p~áii1~~(::·::_:: _~?~~llf!1PE!~éJlç()~l1o/.f.:I~I!~~PéJ~f!lE!_I1!..____ 11849 i Kern County Environmental Health -·1~~!~r~~iri:<?:>~~iXg~y¡r.?~ii1~~t~t:B~~Jih.-m.m.-- !~~!º~E!f!I.~~l1o/..~!:'''.!r.()l1f!1E!'.l_téJ!'.::IE!éJJ!~m_m___m 11849 Kemº()LJr¡tyE:r¡\li~()r¡.f!IE!.I1!<3Lf:!E!éJ~mm_mmm_ ~i':1j;1~.<::c:>:[)i\l:._()!..~I1.".ir.:..f:!E!.éJI!~_!?_E!~ices 11 Kings Co. Div. of Envir. Health Se -1·1849¡~!~~~ç~.þiy._~i¢_~ÿir.:B~~it~~~~ o. Div. of Envir. Health Services ..............--.-............. ent ......................-........ ent ..................................... 10310jLos Ar¡j;leles Cou':1ty ~pt. PubJjcWork~_m 10310!Los Angeles County Dept. Public Works ::·j§~iºI~~s~riº~I~~¢9Ù~ïyº~é~.-þ~þï!~v.Y.~~~~: _.~~1!)1~()~~.I1!1~I~~_ºc:>LJ':1tyqf3pt:£'I:!~!i~~()_r1<~_. ..~~1!)J~c:>~~r¡I:!E!le~~lJr¡t)'ºE!pt:F'~blic:~()r1<~m_m 9816¡Los Angeles County Dept. Public Works j~!º~I~~~~rÏ~~les<?:>~htyþ~pt.~þ~~li~:v.Y.~~~---- ........._.1.1.~¡¡.3i~()~~I1!1E!I~~.<::c:>I:!':1t)'..[)f3P!:F'~~lic:.~c:>r1<~m . 10369iLos Angeles County Dept. Public Works 9684¡MerœëïCo:ErÏv¡ro~meht~ïH~?I!~-:ï)ePt: _~':1".irol1.f!lE!l1t<3.I'::I.~éJ.lt~ml?E!pt:m E_I1\1ir().n.f!I.~.n.!~I..f:!E!éJlt~_~E!pt.~..._m 9684! Merced Co. Environmental Health Dept. 9684rMerceª.e:o.:·gÓ;.,¡r~~rÏ1e.ÓïïïŒ~~iitÏ.~é~___ 9684 ...ç():~I1.\lir().l1f!1E!':1!~I_!:If3?I!~ºf3£>!~__m 9816 Co. Envir()r:'f!lf3':1t!'!.I._f:!E!.éJl.!~.~e!:____ m...........m_ç()~..~I1\1.i.r<:).n..f!I'3._l1téJl...'::I~?~~_.ºf3p.~__._ ! Merced Co. Environmental Health Dept. T-··ª·¢~·:ghy¡~~~irie.Ót~L8iïïi!ri:!?~~:=:_ ....cI..ºc:>:...~r:'\lirc:>r:'f!I.~.r¡.t~I...f:!E!a.!!~m~P!:m__.m 98161 Merced Co. Environmental Health Dept. - S~INAs·....1CA.· =¡ii~t=i~=.=. ~dæmi.~ MON~~:~~ . mm ·1d}- 05----Im··--~ä1~j~~~:~~:~¿~:·~~=::~~~t~~~~;~·-- . .....mmm....._............_._............................_..... ..........._......._..+.............._......m..._.._l.............................................................__....._......................._...._.__._........... TEREY ¡03 30 ; 9816¡Monterey Co. Heatlh Dept.: Monterey 1!~~I~==[I:¡~i¡1~~:~fti~r_ IY.~~~!!:>I:: 101 m ~º. ! 11 iverside Environ!11ental Health Services ==~J~i~g~~J~g:::~=J~~--__~::==t=~j:¡~~fl~t:.:~:~:-$~t.f~~~:.~i:ï_~:.~J.~~;gJ.:~~~~- . ....i~!y~_~~.I!:>É.......i Q?_ .._m__ ! 118491 Riverside Environmental Health Services mm.__lº!\..._m.J.~.IY.I:~~![)É.____.mjg1..___ ._..'~:.~:1-4~!61Ri,;.~!S¡ëïeE~v¡¡:o~meïïtaJHe~It~:~~iY¡~~::: ..................._.._m....__.__.. BAKE~~~I~~º..¡.<::~._ mmJ~~~1>J ...........-.....-.........- .-......-.--p...................... ..........--.....-..........-..... ...-..............................--. .........-....................... .......-..................................-..--. .. :< -.-.......-...-.........----............... ····....·__·...·............_........h_ "'mn ...........__.........__.....__ " --- -149761 R¡~~;:;;iëïëE~~i;:~~;;:;ë;:;ïãïHëa~hSë;.;;¡œs---- ·149761 RI~ërsideËn~iro~~ë;:;ïãïHeãlïtisërViœs--- .'.... . m. .. ... no ,. . .......... m....m ._.......... ....... ................ .................. .......... ....... . _". 11849 ¡ Riverside Environmental Health Services ... .. "11849; Ri~e;:sidë~ri~i;:önmëriïãl-¡.¡e~li~$eiy¡CE!s .~. . ~6L~iyE!~~_eE:r:'Yi.r.9I1nl¡¡I1!?!H.t;!~I!~ §t;!r:yi<::(¡5.__ .. Riverside Environmental Health Services .. .................. ..... ..... ...-- Riverside Environmental Health Services ..... on. ..... ................. ................. ........m..... m..... "'n"'"'' Riverside Environmental Health Services .....m... .n........ .............................................................................. erside Environmental Health Services "m. .n . ..... nom....... n' ... ........__.......... ........ .n_ no iverside Environmental Health Servi .................... __.hm._. .. .......... ....................................._.. ._. iverside Environmental Health Services 9816rRi~erside Envi;:önmë~ïãiHeãiÙiSë;.;;¡œs- - ... · -98..161~ivërn.id~-~-~yiiohÏŸ1~~ïa.18~~i!ïï _~~iYi~i .- 9816i Riverside Environmental Health Services ... ····9816rRi~ërSidëE~~iiö~~ënï~i ¡::¡~ïïh-S~;:;;;¡œs-- · . 9816 I~ive_~id~_E~~I;:~~~~~ï¡¡}H~a.li~_~~;Viëes- 816 . nmental Health Services ......-... ......... 9816 Riverside Environmental Health Services 98161 Riverside Environmental Health- Serviœs ...... no ...... l' .. .., "... ___ ... _.._ .... ......................... .... m.. ... . · ·:i~cil ~:~~~::~~t~:~~~~:~l::~::¡i~-~:~\~:-- .-- -9-816rR¡~ërS¡deEn~i;:o~;ne;:;ïãïHëãiïïï SerViœs -j~à~6Œiÿ~r.~¡~~¢nÿiiiJ.~rrï~~~¡ïCï:!~~i!~~~~~~_.~ .. _.. __ ~81.6¡~i"'~~i<ie Eny~r.9I1I!1¡;¡r:'ta.Jf.:I.~¡:¡!!~§E!.r:vï~_s _ ..__~??8t~iyt;!~id.~.~r:'VJ!9.r:'rnental Health Services 1--. ......~72131~i"'E!rsi<:le¡~I1"'J!()I1I11~r:'t~It!~I!~_~E!!Yi~_ 1-- --iiói~j~¡ç:i::~:~~ç:i~~~:~i::-~:::~-~:~:~:- .¡---- 12023! Ri~ersi(iëEn~¡iõrïme~tãj¡:¡eä-ltïlsë;:v¡ëes- -. -, ·---151~r~i"er.sid.~-En,,¡ro~iiïëhï¡¡jE~ai!~~~~i~S-:= 15154: Riverside Environmental Health Services .......... . ... ~ ...... ..... . ..... no..... _ ..... ..... .... .m..m......m.... ....... 0_.. ....... .......... .. 1_49!6! Rive~i(j.e...!=:l1vironrrl~.r1'.é1.J .-E!a.'.t~~E!r:yi~s . 14976: Riverside Environmental Health Services . '14976TRiveisldeEnvironnïë;:;iãi,:Jëãïiïï-Se;Vlœs ... .... .... 15154jR()seville Fir~[)E!partm~!1t . _~ ?1541RosevillE!Fir~ l?~pa~rne.l1t'H_ ...... ..149!6J Sacrarne_~to <::'9: . En",i.r., ~e~lth[)ivisi.on . 11849!Sacramento Co. Envir. Health Division _.:1 ~¡¡'!~ r1)<lcr-;:;m~n!?Co:~rlV¡~,8..e.~!t6þivi~¡on_-- 149761 Sacramento Co. Envir. Health Division 14976:Sa¿;:amenlo Co, En-ýir:-H'ealth Division '.. .. .. i'" . .... m. ,.... ....-... . ....-... --..-.. 11849!Sacramento Co. Envir. Health Division .. ... ~ mn... ..... ~~... 11682] 1)ac!ame.!1to Co: E:nvir.,:,!~§.II!~[:)ivisio~ 11682iSacramento Co. Envir. Health Division 11682¡Sacramento Co. Envi~: H;;alth Division n. ...._....._...._. __ _..... 1168.2 ¡Sa'!'3rnentoCo.~,:!~ir. .Ii¡;¡al!h [)ivi~ic:>n_ __ 11849iS~n_Bel11~.rd.il1C)<::,c:>ul1o/ ~.I?!H~M.at_'?iy.__ ....... ......__¡_Sal1 Ber.n..ar~il1().<:;()_'::'I1!Y. .F.~I:):.:.t!~<Jt .I?~y..:.... , 11 ,San Bemardino County F.D., HazMat Div. ._ . _ . __- [:!1~~I~~~~ï3~rrîa~~¡I1~ª~lJ~!i.Ë:~:~8~~~~f[j!~:-': i01 05 i 96841 San Bemardino County F.D., HazMat Div. M§ :: __ _ ]~~ - - - in~~~_~~:~~ ~l~f--·~~.----_:r=.:ii~~r$.:~J:;~~~¡~~:â~~~~-~:~~~~:fK~:-.: AL~Y-- - ... - ---r âÁ---- J :~~~À~ri:~6 ...... !6~-- I---}~ ~~¡ ~.~~. :::~~~¡~~¿~~~~~~ri:~· ~:~:}6:Ç:" rcji~~¡~~I~i=fF -r-¡~:!~~!~i~~!tt:~= APPLËVAï:LEVTcÄ - _ --I BERNARDiÑo -¡ 03" ... --98 16! sari- Be;:;¡ãrd¡~o¿o~~ïÿF :D:: HæMãïD¡~~- - ~~~r:~~~ Ja~~J~ ·~~Hm~~~~~i:~~_ ~~~~=~~ ¡ 2700564 [2700736 ;...--............-..- 12700736 ¡ - :2700801 1??_Og80_1 12700837 j--- ."'."'-."-... : 2!99¡¡3?: 12700872 . .....-. ._....__... l2?º~23 !??9Q~- ! 2700348 1____··_·_ i 2700358 r·····-·-·-···-·····- '2700358 1··______ ; 2700489 r2~OQ~8~- ..... .....mm..........._._ .. 2- '. ...······...·...··_·········v··........._ ..........._................_........ ........__...._....._......_.......... 9816iSan Bemardino County F.D.. HazMat Div. ~~1?1~;3~~~!:".~r~ill(:)¢<)~Il!Y~,Q:.~8~~~~(Q~:__ i 9816íSan Bemardino County F.D., HazMat Div. T-=-~~i~I§~~~~~~;~in.?-¢?~Ót~:Ë:þ·:F~t.1~!~þ¡.:;:: J::~-_-II;~~1~:.6~:~:.~:~~¢~~ri~~:~:~p~~¡j·~:~::: ·---H~~j~:~~=~:i~:~~ ~~~~ty ~:~:: ~ --118491sanBemardino County F.D., H :-j1~~I~~~~~r.;;~~ª¡n~¢{¡~n~¥.Iþ~..E ~1_~~~j~~IlI:3E')!:".¡¡~~illf:).Çf:)~llty~:Q:''::I___ ······~i~~I~:~~=~:i~:~~··¿~~~~{-6::~¡¡~~¡¡!Q~y:- . ____-~?2.~I§~Ó:~~;;ï~!~in?£f:)~llty.f':Q:!'::I¡¡~~¡¡t 12032¡San Bemardino County F.D.. HazMat 12032]$~n:~~;;ï~~in~¢{¡~nïYIþ::E~t;1~Iþ¡~; ~¡¡IlI:3E')!:".¡¡r.~illf:)Ç(:)1,!lltyf':Q:!.I:I;3~~¡¡tºiy., San _Bemardill(:)_Cou~ty.f:-º:,_'::I<!!!:~at Div. 54iSan Bemardino County F.D., HazMat Div. _~~I~T§~~~~;;ï~~ª!~{¡¢?~~tyË:þ::~B<!!!:~~~þi~::: ...~.~!~~ .~~!:1..I:3E')!:".¡¡.~d.illf:)_Ç(:)':I!:'ty_f':!?:!!:!~~;3!º!y.:__. 117~¡¡IlI:3~!!.1.;3r.d.ill(:)Çf:)~!:'tyf'!º.:'_I.:!<!!!:~¡¡!!?iy:__ ..._ ~~!:'I:3E')!.Il~r~illf:).Çf:)':Ill.tyf'.:º:'_'::!<!!!:~;3tQiy.:.__ ._._.._....!:I~16 Sa_Il.~~lT1ardino Cf:)un!Yf,Q..l-!azMat Div. ___....~~1?~~IlI:3E')I!1~~d.ill.f:)<:;()_lJlltyf'.:!?:.'_'::I~~~.~t-ºiy,__ ...~~I1l;3r.~il1()_Çf:)~l1tyf':º.:!'::I<!!!:~~!.._[)!y:_ Bemar.~!Ilf:)_Countyf':!?,!l:"IazMat Div. ~~I1l;3r.d.il1f:)Ç(:)~l1ty._~:Q:'_'::I¡¡~~¡¡t.!?i.":_._ _1:3~1!1~r.~illf:)_Ç(:)1,!ll.ty..f':.º:!_':'<!!!:~;3t[)iy., ...~~!:".~~il1()£f:)~l1ty__f':º:'...'::I~~~¡¡![)!y:_ Bemard.ill(:)_<:;f:)lJ.Il!¥f':!?!!....'::!<!!!:M.é!!..Q.iy.:.. H~é!lt~~~r\I!(;E¡~ Department eal!h S~r:Y.i~¡¡ Depa_______ ealttJ..~~r\li~¡¡~Pé!r:.tI!1f:)llt_.. iego _Health Services Department ~~42.i~~Ilºi~g(:)f:f.~~lttJ~~r\li~~º~p;3r:.tI1lf:)rI! , 118491 San Diego Health Services Department _ --- ]: ~ 11849 ¡ San Di~gO_ Hëalth S~~ices DepartmenÎ -- i 9684ISan Diego Health Services Department 196841sanDiegoHeaitiïSeïViœsDepartment-- ..... ... ··--·········t§~n.þi~~8~~ïïF§~rYi~~þ~p~~!!ï~n.ï········· :................1?1?:4!~;3Il.ºiEJ.9(:)..'::I~~lttJ~f:)r\li~~-º~p;3rtl1lf:)llt ·..._.1 151541San Diego Health Services Department ~ ~~i~I$~nþi~9~B~~ijh§~rYi~~Þ.~pa~~~~ïl ····~¿·~·~j·~:~·-6::~b~::¡m§:~f~:-6=~:~~:~i ~~j~T§~riþ¡~~H~~ïï~·$~rY¡~~:~Þ.~¡;~~~~~ï_____ ~~1.!3J~;3r1PiEJ.9(:)_'::IE')~lt.tJ~~r.yi~~~P;3'!_I1l~r1t_____ __!:I_~1.!3I~~Il.!:>iEJ.9(:)f::If:);3I!tJ.~E!r:"':i~¡¡º~e~r:t.Il:!":Il!__.__ ~1~~!:I San JoalJir1Ç~:~lly!r()!!_~E!~~!tJl?iy.i~if:)1l. ___~1.¡¡~~ ~~.n_~f:)~9':1iIlÇ(:):J::_llyiEf:):!!:!E!¡¡I!~ºiy.!~!(:)!1___ 05 I 11849 San Joaquin Co. Enviro., Health Division 20--·-··,·-··--·-1i849!SänJoaqu¡nCO:En~¡ro~-:¡:¡eaïïhD¡;¡ision-- 30--_1.1_8491§.an Jo~quill Co~ EnvirÒ:._8~~!h D!Ÿisi~n - 98 ~.? ~~Il~':I~s_<?_b.i~p.()..Ç():g_f:)pt:_(:)!~r1y.:_':'~¡;¡I.t.tJ...__ 16 an _~lJ!~g~i¡¡PI:>.Çf:):_[)~pt:f:)!~r1y':.':!~~I!I..'.__ ---¡03----- ..!:I¡¡ 16_~lJL~.ºþi~PI:>.~:_I?E!P!:f:)!.J::~Y:f:f.,,:a!!~_. ·:-j:QI.":=:·: 14976 _~~i_¡¡<?~i¡¡PI:>.Ç(:):.~e!,...(:)f..'~IlY:...'::I!!¡¡lth 102 11849 Luis Obispo Co. Dept. of Env. Health --:Jº1~::::~Q5 1 00~1~-;n~~I~~j~!~~:þ~¡;~~~~nj::-:=:_-:~:~::_~- ----JQ:2....._.__.._.___.! ºº!'i_~ afael Fire Depé!rtl!1~ll.t__ ______ ___......_______ . om! 03 ......___.~?º~!:I ._....__________......______ _____________________ .. ______JQ_1 .1.~~~!:I _a~ç(:)~Il!y....~i.~_~p¡;¡rt!.ll~Il!_...__ ____ _ _ __ L.oM~OÇ _ n _ C~ _ ____ !B!,-RBA~ __ _ _ 102____ 11849¡;¡!:Þ~~~_Ç()':Irltyf'i~_ºE!P¡¡.r!!:".~!:'!__ .. ------~Ä:~~:~t6-- -{ â~ __om: -_- ..i ~~tÁ~~ -_::-__JÖ~~-:::-~__ -Q~:-:=]--:..:::~~~}~i~~::~~:â~~~:~~1~~g;6i:.t~~~:.:;~:~¡-- FAIRFIELD 'CA ¡SOLANO 103 20 i 9816iSolano Co. Environmental Management - - - - - - -= :r.~~~ºç~_--:_::k~:_=1~!~~,~~~§::~-Jºj:·--------·------ªi_~l~!~~ï~i~~iç?::Þ.~Ç;;f:~~~j~:=~·~~~~~=:: TUR~ºÇ~____.LCA ___ ....J~:! .A.~ISLAUS_~~~?I~t¡¡lli~l;3lJ.~._Ç<>:!º~p!:(:)fE:rIy'ir:.'3.E!.~()lJ.~~¡¡__ 3 " r Circle K Stores Inc. - Certificate of Financial Responsiblity Site List 12/17/04 through 12/17/05 :2701940-------- 16ÖÕ-WMÄiÑ:sr------m------ ruRLoëK--~~]ª~__m -- ¡srÄÑïsLÄus- -]0-3 - - ...-~~~~_:::m--:=~~5~r~~~¡~i~~~:~~;~~P!~i(~~ÿIr;~~~~:;¡i~~~.=. 12708843 1640ïïi:cÄRPENTERlio--mm---MoDEsTo- ICA -lSTANisLAUS - - 101 . 9816'Stan I Co D pt fE Resources [2708843 . -1640N~¿ÄRPEÑTË-RRD ·--···MOOESTO-- ···-¡¿Ä- m::J~f~~i§~p~:-_]º-m-··j:---:::~¡Ù~I~:~~::ï:~i.~~:Þ:P!~~{g~0~~~~~~:~r~~::-= ¡~?:q~ïHª:m................. --ºN::ª:§~~~f~RRD ........m.. m....· _~º~ESTÓ···mm·¡¢Ä_- ¡§!~~I§~~§__...mJº_ ¡ .......__..~1§1§t¡¡~i~I¡¡~~E~~:,~pt:..~f~f.:I.\fir.:..~~~?~~~~m.m. !?'!QJ156 FRANKLIN AVE Y-':I!lAÇr:r.Y lCA ,SUTTER i 149761 Sutter County Department Of Agriculture f~jó~~~-m------~~¡~:~~fb~~Ä!Ë ·ÒjÄ~ÇI!y lâÀ - - -~~~0~~- m~::m~:i~1il~~~~~t~~~~~~;~~~~~~~~~~~~~~:_ :270104S-------·--,1408vENTÙRÄAVE· OJAi---'---r¿Ä-1vËÑTuRÄ--- 9816iVentura County Environmental Health ¡~~~~~~=::::-:: ~~~§~~~~~~l~:----- ~Á~TÄp~~:I~~m···--:lg~~~g~-: ......j_.._..-_.._m-.........._~.999.·...·.:8·...-.....~1·.....~6·_:.I·.~v·.-.·.._::e..·.-.~n··...-...:t:.-.~u-.·-.-_~ra··..·.._~.-_·~C:_.·...~o·.·_-.uuu......_.~n..-.·.:ty.....·...·.-.....~E-.··.._.~~:...·~v-...-.:.i-.~r..oo·..·.~._~n~.-.·.~m·...._~...:e·...:.·.nnn.-.:.:t·.·.:a-...-.I,·.-.-.~H..-.-_·.:ae-.....-.aa-_:.·.~It·.ï.._;h-.-.·.....=...._-.-.:.-.-..._~.._:.-_.-.. !27·Õ523ã·--··-··-·...-·M.. ·765··W-HÄRVÁR[i-BlVD............··h._._....._...._~- '~iÄNTÄ"pÄij'LA""TcA "T\iËï~:JTURÃ _ _ . r~?'º-1]5~:=:-:==:: I~~:~~:B._~yº-:-:m.-._..... ÓÄVÎS·--···-······-mj¿Ä·m-_m·1·YOLÓ--·· ...¡m_mmm~~_1.?IX()I<:>Ç~:..£?~P.!:5~!..~~....i~~~!:'1~~!~!'::I~_1iI!~..._ E't= iE~1~~= -=~ ~~~~ ~ : L:9¡_·_···-88~_·~1:_66:_··I:y~_Y:u:_bb~_aaa-- ~-~cc_:o~--uu~~_n~_e!Yi:~c~_-U~--:~pP~_AA~-~-:~:::~~-;~-~:--~~_:_:~_h_____~.:-=_-_. L~!º~~L_....__ _8.~.~_§I______ ..mmmmmmmm_ .M~~y~yi1I~-:IªA::.:]x[~A:--- l?'!Q~~!___._._.__ ~~.~_~!_.._.....__.__ . .~~~X~\.'.I!:~~..._lçA.._...m.....mJX!:JBA PRODUCT CODE: 05- unleaded regular 20- unleaded plus 30- unleaded premium 45- diesel 4- " . Circle K Stores Inc. Western Business Unit 495 East Rincon, Ste. 150 Corona, CA 92879 Ph. (951) 270-5193 8M Fax (951) 270-5121 December 21, 2004 Bakersfield Fire Department 2130 G Street Bakersfield, CA 93301 RE: Submittal of Self-Certification Forms for Circle K Sites Located in California Attached is the Certificate of Insurance for Circle K Stores Inc., effective December 17, 2004 through December 17, 2005. Please contact me at (951) 270-5193 if you have any questions regarding this submittal. , ' s~ Michelle Wilson West Coast Environmental Compliance Manager cc: File