WAC 173-360A-1097. Appendix R — 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] Owner or Operator Attorney for Owner or Operator (notary) Date [Signature(s)] Claimant(s) Attorney(s) for Claimant(s) (notary) Date