WAC 173-360-499
Appendix
J -- Certification of valid claim.
CERTIFICATION OF VALID CLAIM
The undersigned, as principals and as legal
representatives of [insert owner or operator] and [insert name
and address of third-party claimant], hereby certify that
the claim of bodily injury [and/or] property
damage caused by an accidental release arising from operating
[owner's or operator's] underground storage tank should be paid
in the amount of $[. . . ].
| [Signatures] |
[Signature(s)] |
| Owner or Operator |
Claimant(s) |
| Attorney for |
Attorney(s) for |
| Owner or Operator |
Claimant(s) |
| (Notary) Date |
(Notary) Date |
[Statutory Authority: Chapter 90.76 RCW. 90-24-017, § 173-360-499, 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.