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�OTE: 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 $10,000. (Chap. 6.75 H&SC, <br />Sect. 25299.32) <br />The Chief Financial Officer or the owner or operator must sign, under penalty of perjury, a letter worded <br />EXACTLY as follows or you may complete this letter by filling in the blanks with appropriate information: <br />LETTER FROM CHIEF FINANCIAL OFFICER <br />I am the Chie cial Officer for MAKE BELIEVE CO.. 123 TANK STREET. <br />(Business name, business address, and correspondence address of owner or operator) <br />FUND CITY, CA 90001; P. 0. BOX 100, FUND CITY, CA 90001 <br />This letter is in support of the use of the Underground Storage Tank Cleanup Fund to demonstrate <br />financial responsibility for tM_dunauthorized <br />e action and/or compensating third parties for bodily <br />injury and property damage release of petroleum in the amount of at least <br />$ 5,000 per oc5,000 annual aggregate coverage. <br />(Dollar Amount) (Dollar Amount) <br />Underground storage tanks at the following facilities are assured by this letter: <br />MAKE BELIEVE CO., STATION #1, 123 TANK ST., FUND CITY, CA 90001 and <br />(Name and address of each facility for which financial responsi�lity is being demonstrated.) <br />1. Amount of annual aggregate coverage being assured <br />bythis letter......................................................................... $ 5,000 <br />2. Total tangible assets.............................................................. $ (Asset Figures) <br />3. Total liabilities....................................................................... $ (Liability Figures) <br />Tan <br />ible <br />worth <br />tract line 3 from <br />4 Line must tbe at least 0 times line 1) line 2: $ (Net Worth Figures) <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 !e7bst of my knowledge and <br />belief. -4 <br />Executed at FUND CITY, CA <br />(Place of Execution) <br />On JULY 3. 199; <br />( Date) <br />U� <br />(Signature) <br />RHEA CYCLE <br />(Printed Name) <br />OWNER <br />(Title) <br />UST 02FR revised 4/95 <br />