CERTIFICATION 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 $[].
[Signatures] [Signature(s)]
Owner or Operator Claimant(s)
Attorney for Owner or Operator Attorney(s) for Claimant(s)
(Notary) Date (Notary) Date
or
S.C. Code Regs. § 61-92.280.H.112