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M <br /> NOTE: Effective July 1, 1995,California Small Businesses and California Businesses with 500 <br /> employees or less 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 Officer or the owner or operator must sign,under penalty of perjury, a letter worded <br /> EXACTLY as follows or you may complete this letter by filling in the blanks with appropriate information: <br /> LETTER FROM CHIEF FINANCIAL OFFICER <br /> I am the Chief Financial Officer for <br /> (Business name,business address,and correspondence address of owner or operator) <br /> This letter is in support of the 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 /> $ per occurrence and$ annual aggregate coverage. <br /> (Dollar Amount) (DollarAmount) <br /> Underground storage tanks at the following facilities are assured by this letter: <br /> (Name and address of each facility for which financial responsibility is being demonstrated.) <br /> 1. Amount of annual aggregate coverage being assured <br /> bythis letter......................................................................... $ <br /> 2. Total tangible assets.............................................................. $ <br /> 3. Total liabilities....................................................................... $ <br /> 4. Tangible net worth(subtract line 3 from line 2. <br /> Line 4 must be at least 10 times line 1).................................. $ <br /> I 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,Title 23 of the California Code of Regulations. <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 <br /> (Place of Execution) <br /> On <br /> (Date) <br /> (Signature) <br /> (Printed Name) <br /> (Title) <br /> UST02FRmvised4/95 <br /> 22 <br />