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Home My WebLink About3601 STOCKDALE HWY (3) State of California For State Use Only. - State of Water Resources Control Board I IIIIIII VIII III IIII Division of Clean Water Programs 67 P.O.Box 944212 IE Sacramento,CA 94244-2120 (Instructions on reverse side) 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 Section 2807,Chapter 18,Div.3,Title 23,CCR: 500,000 dollars per occurrence I million dollars annual aggregate or AND or ® 2 million dollars per occurrence ® 2 million dollars annual aggregate B. 7-Eleven, Inc. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C :Mechanism " Mechanism Coverage Coverage: Corrective. Third.P.arty': T e Name and Address of Issuer Number Amount Period Action Com Liability Insurance Illinois Union Insurance Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence& 4/30/2011 436 Walnut Street 006 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2012 Aggregate 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 with all conditions for participation in the Fund. D. Facility Name Facility Address 7-Eleven #17721 3601 STOCKDALE HWY, Bakersfield CA Facility Name Facility Address Facility Name Facility Address E. Signature of Tank Owner or Operator Date Name and Title of Tank Owner or Operator -�L C�t 4/29/2011 Stephen Boyd �. Region Gasoline Environmental Compliance Mgr. Signature of Witness or Notary Date Name of Witness or Notary i , ~' 4/29/2011 greanna Harmon CFR(Revised 04/95) FILE: Original-Local Agency Copies-Facility/Site(s) DR Kan Co.CA Environmental Health Services 1285 111311111 68 IE STORAGE TANK CERTIFICATE OF INSURANCE TO DEMONSTRATE FINANCIAL RESPONSIBILITY STATE OF CALIFORNIA Facility Name and Address: Per the attached Facility and Tank Schedule Insurer Name and Address: Illinois Union Insurance Company c/o ACE Environmental Risk, P.O. Box 1000, 436 Walnut Street WA07A, Philadelphia, PA 19106 Policy Number: UST G237 9486A 006 Policy Period: From 12:01 am April 30, 2011 to 12:01 am April 30, 2012 Insured Name and Address: 7-Eleven, Inc., One Arts Plaza, 1722 Routh Street Suite 1000, Dallas, TX 75201 I. The Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following Underground Storage Tanks: Facility Identification No. Number of Tanks Per the attached Facility and Tank Schedule for taking corrective action and/or compensating third parties for bodily injury and property damage caused by either sudden accidental releases or non-sudden accidental releases or accidental releases in accordance with and subject to the limits of liability, exclusions, conditions, and other terms of the Policy arising from operating the underground storage tanks identified above. The Limits of Liability are: a. $2,000,000 Each Occurrence b. $2,000,000 Annual Aggregate exclusive of legal defense costs, which are subject to a separate limit under the policy. This coverage is provided under policy number UST G2379486A 006. The effective date of said policy is April 30, 2011. II. The Insurer further certifies the following with respect to the insurance described in Paragraph I: A. Bankruptcy or insolvency of the "insured" shall not relieve the Insurer of its obligations under the Policy to which this certificate applies. B. The Insurer is liable for the payment of amounts within any deductible applicable to the Policy to the provider of,corrective action or a damaged third-party, with a right of reimbursement by the "insured for any such payment made by the Insurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. C. Whenever requested by a Director of an implementing agency, the Insurer agrees to furnish to (the Director)a signed duplicate original of the Policy and all endorsements. ACE USA,Copyright 2003 D. Cancellation or any other termination of the insurance by the Insurer, except for non-payment of premium or misrepresentation by the "insured", will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is received by the"insured". E. The insurance covers "claims otherwise covered by the Policy that are reported to the Insurer within six months of the effective date of cancellation or non-renewal of the Policy except where the new or renewed Policy has the same Retroactive Date or a Retroactive Date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the Policy Retroactive Date, if applicable, and prior to such renewal or termination date. "Claims" reported during such "extended reporting period" are subject to the terms, conditions, limits, including limits of liability, and exclusions of the Policy. I hereby certify that the wording of this instrument is identical to the wording in 40 CFR 280.97 (b) (2) and that the Insurer is eligible to provide insurance as an excess or surplus lines insurer in one or more states. Authorized Agent William P. Hazelton Name Sr.Vice President -ACE Environmental Risk Title 436 Walnut Street, Philadelphia, PA 19106 ACE USA, Copyright 2003 2011-2012 CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven,Inc. (formerly known as The Southland Corporation)hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR part 280. The financial assurance mechanisms used to demonstrate financial responsibility under 40 CFR part 280 are as follows: Storage Tank Liability Insurance Policy No. UST G2379486A 006 issued by Illinois Union Insurance Company, effective April 30,2011,through,April 30,2012, with a retroactive date of November 24, 2005, and covering underground storage tanks for taking corrective-action and/or compensating third parties for bodily injury and property -4�.damage,caused-by-accidental::reteases=in:-the-amount of W-0U MILL'ION�D019LARS' w T ($2,000,000)"per occurrence" and TWO MILLION DOLLARS ($2,000,000) "annual aggregate" as specified by 40 CFR §280.93; and To the extent of its eligibility,participation in various State funds and State assurance programs as set forth in 40 CFR §280.101. W- N, e ncrans Title: Vice ide t,.Gasoline Operations Date: S/' // STATE OF TEXAS ) COUNTY OF DALLAS ) SUBSCRIBED AND SWORN TO BEFORE ME day of 2011. ,;►�l. CONSTANCE E.ROBERTSON Notary Public.state of Texas My commission Expires Februory 04, 2014 Notary Public In and For Said County and State My Commission Expires: 516202.51SPn608$1W5A9MI I 7-Eleven Store List CA Site Address city State Zi p County #of USTs 33163 7100 Dougherty Rd. Dublin CA 94550 Alameda 2 21324 2125 MONTE VISTA AVE. Oroville CA 95966 Butte 3 22468 7 E. GRIDLEY RD. Gridley CA 95948 Butte 2 22474 98 TABLE MOUNTAIN BLVD Oroville CA 95965 Butte 2 32401 1111 FOREST.AVE. Chico CA 95926 Butte 3 16693 774 PORT CHICAGO HWY Pittsburg CA 94565 Contra Costa 2 23837 4001 PACHECO BLVD Martinez CA 94553 Contra Costa 2 32235 530 Morello Ave. Martinez CA 94533 Contra Costa 3 32305 4901 Lone Tree Way Antioch CA 94509 Contra Costa 3 32604 4101 Concord Blvd Concord CA 94519 Contra Costa 2 32787 2437 Main Street Oakley CA 94561 Contra Costa 2 33374 4600 CENTURY BLVD. Pittsburg CA 94565 Contra Costa 2 18922 420 E BULLARD Fresno CA 93710 Fresno 3 19835 6015 E KINGS CANYON Fresno CA 93727 Fresno 3 24180 4246 W ASHLAN Fresno CA 93722 Fresno 3 24526 3005 W. ASHLAN AVE. Fresno CA 93722 Fresno 3 25585 1170 CLOVIS AVENUE Clovis CA 93612 Fresno 3 32625 6875 N. Milbum Ave. Fresno CA 93722 Fresno 2 15047 2620 S. LAKE TAHOE BLVD South Lake Tahoe CA 96150 El Dorado 2 18916 35015 FREMONT BLVD Fremont CA 94536 Alameda 2 19168 3868 DELAWARE DR Fremont CA 94538 Alameda 2 16329 1701 PACHECO RD Bakersfield CA 93304 Kern 3 17721 3601 STOCKDALE HWY Bakersfield CA 93309 Kern 3 18655 300 NORTH CHESTER AVE Bakersfield CA 93308 Kern 3 22647 12916 ROSEDALE HWY Bakersfield CA 93312 Kern 3 26599 6529 EAST BRUNDAGE LN Bakersfield CA 93307 Kern 3 26701 1540 BEAR MOUNTAIN BLVD Arvin CA 93203 Kern 2 26819 3124 N CHESTER Oildale CA 93308 Kern 3 27122 1124 6TH ST Taft CA 93268 Kern 3 32241 4101 Calloway Dr. Bakersfield CA 93312 Kern 2 32257 5203 Olive Dr. Bakersfield CA 93308 Kern 2 32376 9600 Brimhall Rd. Bakersfield CA 93312 Kern 2 16373 1110 N LEMOORE AVE Lemoore CA 93245 Kings 2 26170 395 NORTH 11TH AVENUE Hanford CA 93230 Kings 2 32266 1339 Vasco Rd. Livermore CA 94551 Alameda 2 32734 2222 Las Positas Rd Livermore CA 94550 Alameda 2 33005 245 Vasco Rd. Livermore CA 94550 Alameda 2 17117 904 CLEVELAND ST Madera CA 93638 Madera 3 16459 2255 GERARD AVE Merced CA 95340 Merced 3 22736 603 E. PACHECO BLVD. Los Banos CA 93635 Merced 3 14258 22760 PORTOLA DR Salinas CA 93908 Monterey 2 16747 1212 FREMONT BLVD. Seaside CA 93955 Monterey 2 . 17488 320 RESERVATION RD Marina CA 93933 Monterey 2 23135 2301 FREMONT ST Monterey CA 93940 Monterey 2 24340 335 S. Sanborn Road Salinas CA 93905 Monterey 2 25802 3076 Del Monte Blvd Marina CA 93933 Monterey 2 32264 1991 Natividad Rd. Salinas CA 93906 Monterey 3 32415 140 Beach Rd. Marina CA 93933 Monterey3 33011 425 Canyon Del Rey Del Rey Oaks CA 93940 Monterey 2 32181 4193 PIEDMONT AVE Oakland CA 94611 Alameda 3 32636 4281 SIERRA COLLEGE BLVD Rocklin CA 95677 Placer 2 32867 2101 Sunset Blvd Rocklin CA 95765 Placer 2 34671 6001 Stanford Ranch Rd Rocklin CA 95677 Placer 2 14098 10246 MILLS STATION RD Rancho Cordova ICA 195670 Sacramento 2