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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 to" -f stat vYYse Id Z <br /> (Business name,busme d correspondcnee address of owner a 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 /> $ Sem per occurrence and$ S<n, � annual aggregate coverage. <br /> (Dollar Amount) (Dollar Amount) <br /> Underground storage tanks at the following facilities are assured by this letter: <br /> I;sem Ex arms Lk 2 561 LAcA— P.� -�� ow 5 S t5 <br /> (Name and address of each facility for which financial responsibility is being demonstrated.) <br /> 1. Amount of annual aggregate coverage being assured <br /> mby this letter......................................................................... $ ��7• <br /> 2. Total tangible assets.............................................................. $ <br /> 3. Total liabilities....................................................................... $ (A'got-6 LD �3 <br /> 4. Tangible net worth(subtract line 3 from line 2. o�S 6 6•e8 <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.l(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 EA'gc.k•1r,l <br /> (Place of Execution) <br /> On gVulaa. <br /> (DaLtq <br /> (Signature) <br /> (Printed Name) <br /> (Title) <br /> UST 02FR revised 4/95 <br />