|
Amount |
EPA Regulations:
|
| Closure (264.143 and 265.143) . . . . . . . . . . . . |
$ . . . . . |
| Post-Closure Care (264.145 and 265.145) . . . . . . . . . . . . |
$ . . . . . |
| Liability Coverage (264.147 and 265.147) . . . . . . . . . . . . |
$ . . . . . |
| Corrective Action (264.101(b)) . . . . . . . . . . . . |
$ . . . . . |
| Plugging and Abandonment (144.63) . . . . . . . . . . . . |
$ . . . . . |
|
Amount |
Authorized state programs:
|
| Closure . . . . . . . . . . . . |
$ . . . . . |
| Post-Closure Care . . . . . . . . . . . . |
$ . . . . . |
| Liability Coverage . . . . . . . . . . . . |
$ . . . . . |
| Corrective Action . . . . . . . . . . . . |
$ . . . . . |
| Plugging and Abandonment . . . . . . . . . . . . |
$ . . . . . |
TOTAL . . . . . . . . . . . . |
$ . . . . . |
This [insert: "owner or operator," or "guarantor"] has
not received an adverse opinion, a disclaimer of opinion, or
a "going concern" qualification from an independent
auditor on his financial statements for the latest completed
fiscal year. |
| [Fill in the information for Alternative I if the criteria
of WAC 173-360-413(2) are being used to demonstrate
compliance with the financial test requirements. Fill in the
information for Alternative II if the criteria of WAC 173-360-413(3) are being used to demonstrate compliance
with the financial test requirements.] |
ALTERNATIVE I
|
1. Amount of annual UST aggregate
coverage being assured by a financial test,
and/or guarantee . . . . . . . . . . . . |
$ . . . . . |
| 2. Amount of corrective action, closure and
post-closure care costs, liability coverage, and
plugging and abandonment costs covered by a
financial test, and/or guarantee . . . . . . . . . . . . |
$ . . . . . |
| 3. Sum of lines 1 and 2 . . . . . . . . . . . . |
$ . . . . . |
| 4. Total tangible assets . . . . . . . . . . . . |
$ . . . . . |
| 5. Total liabilities [if any of the amount
reported on line 3 is included in total liabilities,
you may deduct that amount from this line and add
that amount to line 6] . . . . . . . . . . . . |
$ . . . . . |
| 6. Tangible net worth [subtract line 5 from
line 4] . . . . . . . . . . . . |
$ . . . . . |
|
Yes |
No |
| 7. Is line 6 at least $10 million? . . . . . . . . . . . . |
. . . |
. . . |
| 8. Is line 6 at least 10 times line 3? . . . . . . . . . . . . |
. . . . . . . . . . . . |
. . . . . . . . . . . . |
| 9. Have financial statements for the latest
fiscal year been filed with the Securities and
Exchange Commission? . . . . . . . . . . . . |
. . . |
. . . |
10. Have financial statements for the latest
fiscal year been filed with the Energy
Information Administration? . . . . . . . . . . . . |
. . . |
. . . |
| 11. Have financial statements for the latest
fiscal year been filed with the Rural Electrification
Administration? . . . . . . . . . . . . |
. . . |
. . . |
| 12. Has financial information been provided
to Dun and Bradstreet, and has Dun and
Bradstreet provided a financial strength rating of
4A or 5A? |
|
|
[Answer "Yes" only if both criteria have been
met] . . . . . . . . . . . . |
. . . |
. . . |
ALTERNATIVE II
|
| 1. Amount of annual UST aggregate coverage
being assured by a financial test, and/or guarantee
. . . . . . . . . . . . |
$ . . . . . |
| 2. Amount of corrective action, closure and
post-closure care costs, liability coverage, and
plugging and abandonment costs covered by a
financial test, and/or guarantee . . . . . . . . . . . . |
$ . . . . . |
| 3. Sum of lines 1 and 2 . . . . . . . . . . . . |
$ . . . . . |
| 4. Total tangible assets . . . . . . . . . . . . |
$ . . . . . |
| 5. Total liabilities [if any of the amount
reported on line 3 is included in total liabilities,
you may deduct that amount from this line and add
that amount to line 6] . . . . . . . . . . . . |
$ . . . . . |
| 6. Tangible net worth [subtract line 5 from
line 4] . . . . . . . . . . . . |
$ . . . . . |
| 7. Total assets in the U.S. [required only if
less than 90 percent of assets are located in the
U.S.] . . . . . . . . . . . . |
$ . . . . . |
|
Yes |
No |
| 8. Is line 6 at least $10 million? . . . . . . . . . . . . |
. . . |
. . . |
| 9. Is line 6 at least 6 times line 3? . . . . . . . . . . . . |
. . . |
. . . |
| 10. Are at least 90 percent of assets located in
the U.S.? [If "No," complete line 11] . . . . . . . . . . . . |
. . . |
. . . |
| 11. Is line 7 at least 6 times line 3? . . . . . . . . . . . . |
. . . |
. . . |
| [Fill in either lines 12-15 or lines 16-18:] |
|
|
| 12. Current assets . . . . . . . . . . . . |
$ . . . . . |
| 13. Current liabilities . . . . . . . . . . . . |
$ . . . . . |
| 14. Net working capital [subtract line 13 from
line 12] . . . . . . . . . . . . |
$ . . . . . |
|
Yes |
No |
| 15. Is line 14 at least 6 times line 3? . . . . . . . . . . . . |
. . . |
. . . |
16. Current bond rating of most recent bond
issue . . . . . . . . . . . . |
. . . |
. . . |
| 17. Name of rating service . . . . . . . . . . . . |
. . . |
. . . |
| 18. Date of maturity of bond . . . . . . . . . . . . |
. . . |
. . . |
| 19. Have financial statements for the latest
fiscal year been filed with the SEC, the Energy
Information Administration, or the Rural
Electrification Administration? . . . . . . . . . . . . |
. . . |
. . . |
| [If "No," please attach a report from an independent
certified public accountant certifying that there are no
material differences between the data as reported in lines
4-18 above and the financial statements for the latest fiscal
year.] |
| [For both Alternative I and Alternative II complete the
certification with this statement.] |
| I hereby certify that the wording of this letter is
identical to the wording specified in WAC 173-360-470 as
such regulations were constituted on the date shown
immediately below. |
| [Signature] |
| [Name] |
| [Title] |
| [Date] |