Virginia Administrative Code › Title 9 - ENVIRONMENT › Agency 25 - STATE WATER CONTROL BOARD › Chapter 590 - PETROLEUM UNDERGROUND STORAGE TANK FINANCIAL RESPONSIBILITY REQUIREMENTS › Section 9VAC25-590-260:1 - APPENDIX I. LETTER FROM CHIEF FINANCIAL OFFICER

Current through Register Vol. 40, No. 24, July 15, 2024
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 "part"ies 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 "part"y
				  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 "part"s 271 and 145:
EPA Regulation for each state of business operations (specify
				  state):
Amount
Closure (Sections 264.143 and 265.143)
$_____
Post Closure Care (Sections 264.145 and
							 265.145)
$_____
Liability Coverage (Sections 264.147 and
							 265.147)
$_____
Corrective Action (Section 264.101(b))
$_____
Plugging and Abandonment (Section 144.63)
$_____
Other State Programs (specify state):
Closure
$_____
Post-Closure Care
$_____
Liability Coverage
$_____
Corrective Action
$_____
Plugging and Abandonment
$_____
Virginia Hazardous Waste Management
							 Regulations:
Closure (9VAC20-60-264 and
							 9VAC20-60-265 C)
$_____
Post-Closure Care (9VAC20-60-264 and
							 9VAC20-60-265 )
$_____
Liability Coverage (9VAC20-60-264 and
							 9VAC20-60-265 )
$_____
Corrective Action (9VAC20-60-264 )
$_____
Plugging and Abandonment (
							 40 CFR Section
							 144.63 )
$_____
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
$20,000
EE ($20,000 to $34,999)
$40,000
DC ($50,000 to $74,999)
$80,000
CB ($125,000 to $199,999)
$150,000
BB ($200,000 to $299,999)
$200,000
BB ($200,000 to $299,999)
$300,000
BA ($300,000 to $499,999)
$500,000
1A ($500,000 to $749,999)
$750,000
2A ($750,000 to $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)....................$__________
4. Amount of corrective action closure and
				post-closure care costs, liability coverage, and plugging and abandonment costs
				covered by a financial test, and/or guarantee under other EPA regulations or
				state programs authorized by EPA under 40 CFR "part"s 271 or
				145....................$__________
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
Statutory Authority: §§ 62-1.44.15 and
					 62.1-44.34:9 of the Code of
					 Virginia; 42 USC §
												6901 et seq.; 40 CFR "part"s 280 and
					 281.