9 Va. Admin. Code § 25-590-260:11
Note: This Appendix may only be used by owners or operators who do not own or operate hazardous waste facilities, or underground injection control wells.
Note: The instructions in brackets are to be replaced by the relevant information and the brackets deleted.
I am the chief financial officer of insert: name and address of the owner or operator or guarantor. This letter is 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" and/or "compensating third "part"ies for bodily injury and property damage" caused by insert "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases" in the amount of at least $insert dollar amount corrective action per occurrence, $insert dollar amount third "part"y liability 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," and/or "guarantor": List for each facility the name and address of the facility where tanks assured by this financial test are located, and whether tanks are assured by this financial test. 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 by the tank identification number provided in the notification submitted pursuant to 9VAC25-580-70 (Underground Storage Tanks: Technical Standards and Corrective Action Requirements).
I am not required to demonstrate evidence of financial responsibility for any other EPA regulation or state programs authorized by EPA.
This insert: "owner or operator," or "guarantor" has not received an adverse opinion, a disclaimer of opinion, or a "going concern" qualification from an independent auditor on the financial statements for the latest completed financial reporting year.
Fill in the information below to demonstrate compliance with the financial test requirements.
Annual Aggregate Requirement | Dun and Bradstreet Rating |
$20,000 | EE ($20,000 to $34,999) |
$40,000 | DC ($50,000 to $74,999) |
$80,000 | CB ($125,000 to $199,999) |
$150,000 | BB ($200,000 to $299,999) |
$200,000 | BB ($200,000 to $299,999) |
$300,000 | BA ($300,000 to $499,999) |
$500,000 | 1A ($500,000 to $749,999) |
$750,000 | 2A ($750,000 to $999,999) |
$1,000,000 | 3A ($1,000,000 to $9,999,999) |
Answer "Yes" only if BOTH criteria have been met. Yes... No...
I hereby certify that the wording of this letter is identical to the wording specified in Appendix XI of this chapter as such regulations were constituted on the date shown immediately below.
Signature
Name
Title
Date
9 Va. Admin. Code § 25-590-260:11
Statutory Authority: §§ 62-1.44.15 and 62.1-44.34:9 of the Code of Virginia; 42 USC § 6901 et seq.; 40 CFR "part"s 280 and 281.