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Delaware General AssemblyDelaware RegulationsAdministrative CodeTitle 710001300Split1351

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Department of Natural Resources and Environmental Control

Tank Management Section

1351 Underground Storage Tank Systems

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FC: 76

DNREC Facility ID#:

The undersigned, as principals and as legal representatives of [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 or Operator] Underground Storage Tank System should be paid in the amount of $[ ______________ ].


[Signature of Owner or Operator]


[Signature of Attorney for Owner or Operator]

(Notary)________________ Date ________


[Signature of Claimant]


[Signature of Attorney for Claimant]

(Notary)_______________ Date ________

Last Updated: February 12 2016 14:12:14.
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