Department of Natural Resources and Environmental Control
Tank Management Section
1351 Underground Storage Tank Systems
1. Amount of UST Annual Aggregate coverage being assured by a financial
2. Amount of corrective action, closure and post-closure care costs, plugging and
abandonment costs and other liability coverage covered by a financial test,
(This includes but is not limited to Subtitle C Hazardous Waste Facilities,
SDWA Class I Hazardous Waste Injection Wells and aggregate AST coverage) $ ___________
(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):……… $___________
7. Total assets in the U.S. (required only if less than 90 percent of assets are located
(Tangible Net Worth at least $10 million)
(Tangible Net Worth 6X's other environmental obligations)
10. Are at least 90 percent of assets located in the U.S.? ……………… [ ]Yes [ ]No*
11. Is line 7 at least 6 times line 3?
(U.S. assets at least six times the required amount of UST coverage
plus other environmental liabilities) ………………………………. [ ]Yes [ ]No*
(Complete Lines 12-15 OR Lines 16-18)
14. Net working capital (subtract line 13 from line 12): ...................... $______________
16. Current bond rating of most recent bond issue: ......................... _____________________
19. Have financial statements for the latest fiscal year been filed with the
Securities and Exchange Commission (SEC), the Energy Information
Administration (EIA), or the Rural Utilities Service (RUS)? ........... [ ]Yes [ ]No*
20. The firm's year-end financial statements have been independently audited
and do not include an adverse auditor's opinion, a disclaimer of opinion,
or a "going concern" qualification…………………………………… [ ]Yes [ ]No*