D.C. Mun. Regs. tit. 20, § 6715
SOURCE: Final Rulemaking published at 43 DCR 2799 (May 24, 1996), incorporating text of Proposed Rulemaking published at 42 DCR 5765, 5782 (October 20, 1995); as amended by Final Rulemaking published at 46 DCR 7699 (October 1, 1999).
UST Facility I.D.
Number
Number of UST(s)
Name/Address of
UST(s) Facility
| Closure (§§ 264.143 and 265.143) | _____ |
|---|---|
| Post-Closure Care (§§ 264.145 and 265.145) | _____ |
| Liability Coverage (§§ 264.147 and 265.147) | _____ |
| Corrective Action (§ 264.101(b)) | _____ |
| Plugging and Abandonment (§ 144.63) | _____ |
| Closure | _____ |
| Post-Closure Care | _____ |
| Liability Coverage | _____ |
| Corrective Action | _____ |
| Plugging and Abandonment | _____ |
| Total | _____ |
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Amount of annual UST aggregate coverage being
assured by a financial test, and/or guarantee.
$______
2. Amount of corrective action, closure and post-closure care cost, liability coverage, and plugging and abandonment costs covered by a financial test or guarantee.
$______
3.
$______
4. Total tangible assets __
$______
5. Total liabilities [if any of the amount reported on line 3 is included in total liabilities, you may deduct that amount from this line and add that amount to line 6] __
$______
6. Tangible net worth [subtract line 5 from line 4]
$______
7. Total assets in the U.S. [required only if less
than ninety percent (90%) of assets are located
in the U.S.] ______
$ ______
Yes
No
8. Is line 6 at least ten million dollars ($ 10,000,000)?
9. Is line 6 at least six (6) times line 3?
10. Are at least ninety percent (90%) of assets located
in the U.S.? [If "No," complete line 11]
11. Is line 7 at least six (6) times line 3?
[Fill in either lines 12-15 or lines 16-18:]
12. Current Assets ______
$ ______
13. Current Liabilities ______
$ ______
14. Networking capital [subtract line 13
from line 12]
$ ______
Yes
No
15. Is line 14 at least 6 times line 3?
16. Current bond rating of most recent bond issue.
17. Name of rating service ______
18. Date of maturity of bond ______
Yes
No
19. Have financial statements for the latest fiscal year been filed
with the SEC, the Energy Information Administration, the Rural
Electrification Administration, the Board of Governors of the
Federal fication Administration, the Board of Governors of the
Federal Reserve System, the Comptroller of the Currency or the
Federal Deposit Insurance Corporation?
UST Facility I.D.
Number
Number of UST(s)
Name/Address of
UST(s) Facility
APPENDIX 67-4
CERTIFICATE OF INSURANCE
UST Facility I.D.
Number
Number of UST(s)
Name/Address of
UST Facility
APPENDIX 67-5
ENDORSEMENT
UST Facility I.D.
Number
Number of UST(s)
Name/Address of
UST Facility
UST Facility I.D.
Number
Number of UST(s)
Name/Address of
UST(s) Facility
UST Facility I.D.
Number
Number of UST(s)
UST(s) Facility
Name/Address of
UST(s) Facility I.D.
Number
Number of UST(s)
Name/Address
UST Facility