APPENDIX A Financial Assurance Forms

Section 811. APPENDIX A   Financial Assurance Forms Section 811.ILLUSTRATION G   Owner's or Operator's Bond Without Surety OWNER'S OR OPERATOR'S BOND WITHOUT SURETY Date bond executed: Effective date: Owner or Operator: Owner's or Operator's address: Site: Site address: Penal Sum $ The owner or operator promises to pay the penal sum to the Illinois Environmental Protection Agency unless the owner or operator provides closure and post-closure care or corrective action for the site in accordance with the closure and post-closure care or corrective action plans for the site. Owner or Operator Signature Typed Name Title Date: Corporate seal