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NOTE: Effective July 1, 1995, California Small Businesses and Califorliia 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 v46 ..5-�D � o ee <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 /> OD°a--.-- per occurrence-and 1 104-AD&— annual aggregate coverage. <br /> Dollar Amount i <br /> � ) (Dollar Amount) - <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.................................:........................................ $ /D, h Dd <br /> 2. Total tangible assets.............................................................. $--5�/, Dao <br /> 3. Total liabilities....................................................................... $ r'a°7 nzsa <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 "'�1b"4/4 , <br /> (Place of Execution <br /> On o u OD <br /> (Date) <br /> i <br /> (Signature) <br /> �g'ma;t�2 <br /> (Printed Name) <br /> ('Title) <br /> UST 02FR revised 4195 <br />