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i <br /> i <br /> NOTE: Effective July 1 1995, California Small Businesses and California Businesses with 500 <br /> employees or le s must demonstrate at least$5,000,exclusive of the UST Cleanup Fund, <br /> businesses with over 500 employees must demonstrate at least$10,000. (Chap. 6.75 H&SC, <br /> Sect.25299.32) <br /> The Chief Financial Offic •or the owner or operator must sign,under penalty of perjury,a letter worded <br /> EXACTLY as follows or u may complete this letter by filling in the blanks with appropriate information: <br /> LETTER FROM CIHEF FINANCIAL OFFICER <br /> I am the Chief Financial O fficer for M A-&.S f toL Li,-k-76'[ ���(5���c�-�� A uct <br /> (Business name,business address,and correspondence address of owner or op tor) <br /> This letter is in support of he use of the Underground Storage Tank Cleanup Fund to demonstrate financial <br /> responsibility for taking corrective action and/or compensating third parties for bodily <br /> injury and property damage caused by an unauthorized release of petroleum in the amount of at least <br /> $ . ice- o0 per occurrence and$ S,.00l)o 17 c) annual aggregate coverage. <br /> (Dollar Amount) (Dollar Amount) <br /> Underground storage tanks at the following facilities are assured by this letter: j <br /> 3 /0 , el- Tc,-.r SL �St-� k� 1 r�v� C <br /> (Name and address of each facility I&which financial responsibility is being demonstrated.) <br /> a <br /> 1. Amount of annua I aggregate coverage being assured <br /> by this letter..... .............................................................. $ '5C-'>00- a <br /> 2. Total tangible assets.............................................................. $ rS�D, or✓c- Ci G <br /> 3. Total liabilities.. ............. ...... .. .......... .............................. $ I4D' c. c <br /> 4. Tangible net wor 1 (subtract line 3 from line 2. <br /> Line 4 must be at least 10 times line 1).................................. $ -�C), •c'- , <br /> i <br /> 1 hereby certify that the wording of this letter is identical to the wording specified in subsection 2808.1(d)(1), <br /> Chapter 18, Division 3,Tit e 23 of the California Code of Regulations. 3 <br /> I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief. <br /> Executed at S TO C— MA) C4 <br /> (Place ofExecutio ) <br /> On O'Cll- 2 C.• , <br /> (Dat <br /> (Signature) <br /> (Printed Name) <br /> (Title) <br /> UST 02FR revised 4/95 <br /> 1 <br />