Ill. Admin. Code tit. 35, pt. 811, subpt. G, app A, ILLUSTRATION G
OWNER'S OR OPERATOR'S BOND WITHOUT SURETY
Date bond executed: ______________________________________________________
Effective date: ___________________________________________________________
Owner or Operator: _______________________________________________________
Owner's or Operator's address: ______________________________________________
Site: __________________________________________________________________
Site address: ___________________________________________________________
Penal Sum $ ______________________________
The owner or operator promises to pay the penal sum to the Illinois Environmental Protection Agency unless the owner or operator provides closure and post-closure care or corrective action for the site in accordance with the closure and post-closure care or corrective action plans for the site.
Owner or Operator _______________________________________________________
Signature ______________________________________________________________
Typed Name ____________________________________________________________
Title ___________________________________________________________________
Date: _______________________
Corporate seal
Ill. Admin. Code tit. 35, pt. 811, subpt. G, app A, ILLUSTRATION G