WAC 173-360-496   Appendix I -- Certification of financial responsibility.  

CERTIFICATION OF FINANCIAL RESPONSIBILITY

     [Owner or operator] hereby certifies that it is in compliance with the requirements of WAC 173-360-400 through173-360-499 .

     The financial assurance mechanism[s] used to demonstrate financial responsibility under WAC 173-360-400 through173-360-499 is [are] as follows:

     [For each mechanism, list the type of mechanism, name of issuer, mechanism number (if applicable), amount of coverage, effective period of coverage and whether the mechanism covers "taking corrective action" and/or "compensating third parties for bodily injury and property damage caused by" either "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases."]

     [Signature of owner or operator]

     [Name of owner or operator]

     [Title]

     [Date]

     [Signature of witness or notary]

     [Name of witness or notary]

     [Date]



[Statutory Authority: Chapter 90.76 RCW. 90-24-017, § 173-360-496, filed 11/28/90, effective 12/29/90.]


NOTES:

     Reviser's note:  The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.