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TE; Effective 3111N.' 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 nest demonstrate at least $10,000. (Chap. 6.75 H&SC, <br /> Sect.25299,32) <br /> the Chief Financial OtTlcer or the owner or operator must sign, under penalty of perjury, a letter worded <br /> EXACTLY as follows or you may complete this letter by filling in the blanks with appropriate information; <br /> LETTER FROM CHIEF FINANCIAL OFFICER <br /> 1 am the Chief Financial Officer forkA 5 A01) da #1 <br /> 0 (13usiness namc,business address,and correspondence ddress of owner or operator) <br /> @mf'A Ave Amteca OA <br /> 3 <br /> O <br /> This letter is in support of the use of the Underground Storage Tank Cleanup Fund to demonstrate financial <br /> s <br /> responsibility for taking corrective action and/or compensating third parties for bodily { <br /> injury and property damage caused by an unauthorized release of petroleum in the amount of at least Z <br /> per occurrence and$ '1 Nl'%//1d� annual aggregate coverage. m <br /> (Dollar Amount) (Dollar Amount) q <br /> O <br /> Underground storage tanks at the following facilities are assured by this letter: z <br /> s •4-- R1-7 o3o Ed„se r, k <br /> (Name and address of each facility for which financial responsibility is being de onstrated.) _ <br /> /I call ff3 <br /> 1. Amount of annual aggregate coverage being assuredby this letter.......................... ............... $ 0 <br /> 2. Total tangible assets.............................................................. $ 1- 2- 1'h ll/dA _ <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 /> R <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. F <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 3� 4 <br /> ,wele' f A7�w � �'p36 <br /> (Place of Exec ion) <br /> On <br /> (mate) , <br /> (signature) <br /> (Prime N <br /> I re <br /> ('title) <br /> UST 02FR revised 4195 <br />