Director
Department of Environmental Quality
P.O. Box 1105
Richmond, Virginia 23218
Dear (Sir, Madam):
I am the chief financial officer or managing member of (name and address of firm). This letter is in support of this firm's use of the financial test to demonstrate financial assurance, as specified in 9VAC25-650-124 of the Closure Plans and Demonstration of Financial Capability Regulation (9VAC25-650) ("Regulation").
(Fill out the following four paragraphs regarding privately owned sewerage systems (9VAC25-650), solid waste, regulated medical waste, yard waste composting, hazardous waste, underground injection (regulated under the federal program in 40 CFR Part 144, or its equivalent in other states), petroleum underground storage (9VAC25-590), above ground storage facilities (9VAC25-640) and PCB storage (regulated under 40 CFR Part 761) facilities and associated cost estimates. If your firm has no facilities that belong in a particular paragraph, write "None" in the space indicated. For each facility, include its name, address, permit number, if any, and current closure, post-closure care, corrective action or any other environmental obligation cost estimates. Identify each cost estimate as to whether it is for closure, post-closure care, corrective action or other environmental obligation.)
This firm (insert "is required" or "is not required") to file a Form 10K with the Securities and Exchange Commission (SEC) for the latest fiscal year.
The fiscal year of this firm ends on (month, day). The figures for the following items marked with an asterisk are derived from this firm's independently audited, year-end financial statements for the latest completed fiscal year, ended (date).
1) Sum of current closure, post-closure care, corrective action, or other environmental obligations cost estimates (total of all cost estimates shown in the four paragraphs above.) | $_______________ | ||
2) Tangible net worth* | $_______________ | ||
3) Total assets located in the United States* | $_______________ | ||
YES | NO | ||
Line 2 exceeds line 1 by at least $10 million? | ____ | ____ | |
Line 3 exceeds line 1 by at least $10 million? | ____ | ____ | |
(Fill in Alternative I if the criteria of 9VAC25-650-124 A 1 a (1) are used. Fill in Alternative II if the criteria of 9VAC25-650-124 A 1 a (2) are used. Fill in Alternative III if the criteria of 9VAC25-650-124 A 1 a (3) are used.)
ALTERNATIVE I
Current bond rating of this firm's senior unsubordinated debt and name of rating service | _____________ |
Date of issuance of bond | ______________ |
Date of maturity of bond | ______________ |
ALTERNATIVE II
4) Total liabilities* (if any portion of the closure, post-closure care, corrective action, or other environmental obligations cost estimates is included in total liabilities, you may deduct the amount of that portion from this line and add that amount to line 5.) | $_______________ | |
5) Net worth* | $_______________ | |
YES | NO | |
Is line 4 divided by line 5 less than 1.5? | ____ | ____ |
ALTERNATIVE III
6) Total liabilities* | $_______________ | ||
7) The sum of net income plus depreciation, depletion, and amortization minus $10 million* | $_______________ | ||
YES | NO | ||
Is line 7 divided by line 6 less than 0.1? | ____ | ____ | |
I hereby certify that the wording of this letter is identical to the wording in 9VAC25-650-124 B of the Closure Plans and Demonstration of Financial Capability Regulation as such regulation is constituted on the date shown immediately below.
(Signature) |
(Name) |
(Title) |
(Date) |
CERTIFICATION OF FUNDING
I certify the following information details the current plan for funding closure at the privately owned sewerage systems listed below.
Facility permit # | _________ |
Source for funding closure | _______________ |
Name of locality or corporation | ___________ |
Signature | ___________ |
Printed name | ____________ |
Title | ____________ |
Date | ___________ |
9 Va. Admin. Code § 25-650-124
Statutory Authority: §§ 62.1-44.15 and 62.1-44.18:3 of the Code of Virginia.