Statutes, codes, and regulations
Washington Administrative Code
Title 173 - Ecology, Department of (See also Titles 197, 317, 372, and 508)Chapter 173-360A - Underground storage tank regulations
Part 10 - FINANCIAL RESPONSIBILITY
Section 173-360A-1096 - Appendix Q-Certification of financial responsibility

Wash. Admin. Code § 173-360A-1096

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Current through Register Vol. 24-20, October 15, 2024
Section 173-360A-1096 - Appendix Q-Certification of financial responsibility

[Owner or operator] hereby certifies that it is in compliance with the requirements of Part 10 of chapter 173-360A WAC.

The financial assurance mechanism[s] used to demonstrate financial responsibility under Part 10 of chapter 173-360A WAC is [are] as follows:

[For each mechanism, list the type of mechanism, name of issuer, mechanism number (if applicable), amount of coverage, effective period of coverage and whether the mechanism covers "taking remedial action" and/or "compensating third parties for bodily injury and property damage caused by" either "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases."]

[Signature of owner or operator]

[Name of owner or operator]

[Title]

[Date]

[Signature of witness or notary]

[Name of witness or notary]

[Date]

Wash. Admin. Code § 173-360A-1096

Adopted by WSR 18-15-083, Filed 7/18/2018, effective 10/1/2018

Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.