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PDFWAC 173-360A-1097

Appendix RCertification 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 $[___].
Owner or Operator
Attorney for Owner or Operator
Attorney(s) for Claimant(s)
[Statutory Authority: Chapter 90.76 RCW. WSR 18-15-083 (Order 16-02), § 173-360A-1097, filed 7/18/18, effective 10/1/18.]
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.
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