9VAC25-590-260:1. APPENDIX I. LETTER FROM CHIEF FINANCIAL OFFICER

APPENDIX I. LETTER FROM CHIEF FINANCIAL OFFICER. NOTE: The instructions in brackets are to be replaced by the relevant information and the brackets deleted. [NOTE: Owners or operators demonstrating financial responsibility using the financial test who do not also own or operate hazardous waste facilities or underground injection wells are eligible to use Appendix XI (Letter from Chief Financial Officer—Short Form) instead of Appendix I.] I am the chief financial officer of [insert name and address of the owner or operator or guarantor]. This letter is in support of the use of [insert "the financial test of self-insurance," and/or "Guarantee"] to demonstrate financial responsibility for [insert: "taking corrective action" and/or "compensating third parties for bodily injury and property damage"] caused by [insert "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases"] in the amount of at least [insert dollar amount] corrective action per occurrence and [insert dollar amount] third party liability per occurrence and [insert dollar amount] annual aggregate arising from operating (an) underground storage tank(s). Underground storage tanks at the following facilities are assured by this financial test by this [insert "owner or operator," and/or "guarantor"]: [List for each facility the name and address of the facility where tanks assured by this financial test are located, and whether tanks are assured by this financial test. If separate mechanisms or combinations of mechanisms are being used to assure any of the tanks at this facility, list each tank assured by this financial test by the tank identification number provided in the notification submitted pursuant to 9VAC25-580-70 (Underground Storage Tanks; Technical Standards and Corrective Action Requirements)]. A [insert "financial test," and/or "guarantee"] is also used by this [insert "owner or operator" or "guarantor"] to demonstrate evidence of financial responsibility in the following amounts under other EPA regulations or state programs authorized by EPA under 40 CFR Parts 271 and 145: EPA Regulation for each state of business operations (specify state): Amount Amount Closure (Sections 264.143 and 265.143) $_____ Closure (Sections 264.143 and 265.143) $_____ Post Closure Care (Sections 264.145 and 265.145) $_____ Post Closure Care (Sections 264.145 and 265.145) $_____ Liability Coverage (Sections 264.147 and 265.147) $_____ Liability Coverage (Sections 264.147 and 265.147) $_____ Corrective Action (Section 264.101(b)) $_____ Corrective Action (Section 264.101(b)) $_____ Plugging and Abandonment (Section 144.63) $_____ Plugging and Abandonment (Section 144.63) $_____ Other State Programs (specify state): Other State Programs (specify state): Closure $_____ Closure $_____ Post-Closure Care $_____ Post-Closure Care $_____ Liability Coverage $_____ Liability Coverage $_____ Corrective Action $_____ Corrective Action $_____ Plugging and Abandonment $_____ Plugging and Abandonment $_____ Virginia Hazardous Waste Management Regulations: Virginia Hazardous Waste Management Regulations: Closure ( 9VAC20-60-264 and 9VAC20-60-265 C) $_____ Closure ( 9VAC20-60-264 and 9VAC20-60-265 C) $_____ Post-Closure Care ( 9VAC20-60-264 and 9VAC20-60-265 ) $_____ Post-Closure Care ( 9VAC20-60-264 and 9VAC20-60-265 ) $_____ Liability Coverage ( 9VAC20-60-264 and 9VAC20-60-265 ) $_____ Liability Coverage ( 9VAC20-60-264 and 9VAC20-60-265 ) $_____ Corrective Action ( 9VAC20-60-264 ) $_____ Corrective Action ( 9VAC20-60-264 ) $_____ Plugging and Abandonment (40 CFR Section 144.63) $_____ Plugging and Abandonment (40 CFR Section 144.63) $_____ TOTAL $_____ TOTAL $_____ This [insert "owner or operator," or "guarantor"] has not received an adverse opinion, a disclaimer of opinion, or a "going concern" qualification from an independent auditor on his financial statements for the latest completed fiscal year. [Fill in the information for Alternative I if the criteria of 9VAC25-590-60 B are being used to demonstrate compliance with the financial test requirements. Fill in the information for Alternative II if the criteria of 9VAC25-590-60 C are being used to demonstrate compliance with the financial test requirements.] ALTERNATIVE I 1. Amount of annual UST aggregate coverage being assured by a financial test, and/or guarantee....................$__________ 2. Amount of annual aboveground storage tank (AST) aggregate coverage being assured by a financial test and/or guarantee pursuant to 9VAC25-640 ....................$__________ 3. Total UST/AST financial responsibility obligations assured by a financial test and/or guarantee (sum of lines 1 and 2)....................$__________ 4. 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 under other EPA regulations or state programs authorized by EPA under 40 CFR Part 145 or 271....................$__________ 5. Sum of lines 3 and 4....................$__________ 6. Total tangible assets....................$__________ 7. Total liabilities [if any of the amount reported on line 5 is included in total liabilities, you may deduct that amount from this line or add that amount to line 8]....................$__________ 8. Tangible net worth [subtract line 7 from line 6]....................$__________ 9. Is line 8 at least equal to line 3 above? Yes.... No..... 10. Is line 8 at least equal to the sum of line 3 plus 10 times line 4? Yes.... No.... 11. Have financial statements for the latest financial reporting year been filed with the Securities and Exchange Commission? Yes.... No.... 12. Have financial statements for the latest financial reporting year been filed with the Energy Information Administration? Yes.... No.... 13. Have financial statements for the latest financial reporting year been filed with the Rural Utilities Service? Yes.... No.... 14. Has financial information been provided to Dun and Bradstreet, and has Dun and Bradstreet provided a financial strength rating at least equal to the total amount of annual aggregate coverage being assured as entered on line 5, according to the table below? Annual Aggregate Requirement Dun and Bradstreet Rating Annual Aggregate Requirement Dun and Bradstreet Rating $20,000 EE ($20,000 to $34,999) $20,000 EE ($20,000 to $34,999) $40,000 DC ($50,000 to $74,999) $40,000 DC ($50,000 to $74,999) $80,000 CB ($125,000 to $199,999) $80,000 CB ($125,000 to $199,999) $150,000 BB ($200,000 to $299,999) $150,000 BB ($200,000 to $299,999) $200,000 BB ($200,000 to $299,999) $200,000 BB ($200,000 to $299,999) $300,000 BA ($300,000 to $499,999) $300,000 BA ($300,000 to $499,999) $500,000 1A ($500,000 to $749,999) $500,000 1A ($500,000 to $749,999) $750,000 2A ($750,000 to $999,999) $750,000 2A ($750,000 to $999,999) $1,000,000 3A ($1,000,000 to 9,999,999) $1,000,000 3A ($1,000,000 to 9,999,999) [Answer "Yes" only if both criteria have been met.] Yes.... No.... 15. If you did not answer yes to one of lines 11 through 14, please attach a report from an independent-certified public accountant certifying that there are no material differences between the data reported in lines 6 through 10 above and the financial statements for the latest financial reporting year. ALTERNATIVE II 1. Amount of annual UST aggregate coverage being assured by a financial test, and/or guarantee. 2. Amount of annual aboveground storage tank (AST) aggregate coverage being assured by a financial test and/or guarantee pursuant to 9VAC25-640 ....................$__________ 3. Total UST/AST financial responsibility obligations assured by a financial test and/or guarantee (sum of lines 1 and 2)....................$__________ 4. Amount of corrective action closure and post-closure care costs, liability coverage, [and] plugging and abandonment costs covered by a financial test, and/or guarantee under other EPA regulations or state programs authorized by EPA under 40 CFR Parts 271 or 145....................$__________ 5. Sum of lines 3 and 4....................$__________ 6. Total tangible assets....................$__________ 7. Total liabilities [if any of the amount reported on line 5 is included in total liabilities, you may deduct that amount from this line or add that amount to line 8]....................$__________ 8. Tangible net worth [subtract line 7 from line 6]....................$__________ 9. Total assets in the U.S. [required only if less than 90% of assets are located in the U.S.]....................$__________ 10. Is line 8 at least equal to line 3 above? Yes___ No___ 11. Is line 8 at least equal to the sum of line 3 plus 6 times the sum of line 4? Yes___ No___ 12. Are at least 90% of assets located in the U.S.? [If "No," complete line 13.] Yes___ No___ 13. Is line 9 at least equal to the sum of line 1 3 plus 6 times the sum of line 4? Yes___ No___ [Fill in either lines 14-17 or lines 18-20:] 14. Current assets....................$__________ 15. Current liabilities....................$__________ 16. Net working capital subtract line 15 from line 14....................$__________ 17. Is line 16 at least equal to the sum of line 3 plus 6 times the sum of line 4? Yes___ No___ 18. Current bond rating of most recent bond issue?____________ 19. Name of rating service____________ 20. Date of maturity of bond____________ 21. Have financial statements for the latest financial reporting year been filed with the SEC, the Energy Information Administration, or the Rural Utilities Service? Yes___ No___ [If "no," please attach a report from an independent certified public accountant certifying that there are no material differences between the data reported in lines 6-20 above and the financial statements for the latest financial reporting year.] [For Alternatives I and II complete the certification with this statement.] I hereby certify that the wording of this letter is identical to the wording specified in Appendix I of 9VAC25-590 as such regulations were constituted on the date shown immediately below. [Signature] [Name] [Title] [Date]