I, [insert: name of chief financial officer], the chief financial officer of [insert: name and address of the owner, operator or guarantor] have prepared this letter in support of the use of [insert: "the financial test of self-insurance," and/or "guarantee"] to demonstrate financial responsibility for [insert: "taking corrective action" or "compensating third parties for bodily injury and property damage"] caused by [insert: "sudden accidental releases" and/or "nonsudden accidental releases"] in the amount of at least [insert: dollar amount] per occurrence and [insert: dollar amount] annual aggregate arising from operating (an) underground storage tank(s).
Underground storage tanks at the following facilities are assured by this financial test by this [insert: "owner or operator," or "guarantor"]:
[List or attach the following information for each facility: the name and address of the facility where tanks assured by this financial test are located and facility number(s) assigned by the Department. If separate mechanisms or combinations of mechanisms are being used to assure any of the tanks at this facility, list each tank assured by this financial test.]
[When appropriate, include the following for Hazardous Waste Management Facilities, Hazardous Waste Storage Facilities, and Injection Wells:
A [insert: "financial test" or "guarantee"] is also used by this [insert: "owner, operator" or "guarantor"] to demonstrate evidence of financial responsibility in the following amounts under EPA regulations or state programs authorized by EPA under 40 CFR Parts 271 and 145:
EPA Regulations | Amount |
Closure (including 40 CFR 264.143 and 265-143) | $____________ |
Post-Closure Care (including 40 CFR 264.145 and 265.145) | $____________ |
Liability Coverage (including 40 CFR 264.147 and 265.147) | $____________ |
Corrective Action (including 40 CFR 264.101(b)) | $____________ |
Plugging and Abandonment (including 40 CFR 144.63) | $____________ |
Total | $____________ |
This [insert: "owner, operator" or "guarantor"] has not received an adverse report or a "going concern" qualification from an independent accountant on his financial statements for the latest completed fiscal year.
Yes No
I hereby certify that the wording of this letter is identical to the wording specified in 15A NCAC 02O .0302, as such regulations were constituted on the date shown immediately below, and that the information contained herein is complete and accurate.
[Signature of chief financial officer]
[Name]
[Title]
[Date]
15A N.C. Admin. Code 02O .0302
Eff. August 3, 1992;
Readopted Eff. January 1, 2021.
Eff. 8/3/1992.