Information Required on Financial Assistance Application
(1)The UST financial assistance application shall include, at a minimum:
(a)The applicant’s name, mailing address and phone.
(b)The signatures and phone numbers of the property owner, the tank owner and the permittee of facility;
(c)The UST facility location information including:
(A)Facility name, street address, city and county; and
(B)Where the applicant intends to qualify for Tier 3 and 4 financial assistance:
(i)The distance to nearest retail gas sales facility if the applicant’s facility is outside an incorporated city measured in accordance with OAR 340-172-0070 (Determination and Conditions of Financial Assistance)(2)(d)(C)(iii); or
(ii)The name of the city, if the applicant’s facility is the only retail UST facility reselling motor fuel within a city listed in the 1991⁄1992 Oregon Blue Book.
(d)The UST facility number;
(e)The date of the application;
(f)Description of the UST project work area including a scaled drawing (contractor’s or engineer’s drawing) showing, but not limited to, property boundaries, location of structures, location and identification of the existing underground storage tanks containing an accumulation of motor fuel. Where AST(s) replace UST(s) the application shall also include:
(A)Description of the AST project work, installation specifications and a scaled installation drawing (contractor’s or engineer’s drawing) showing all information necessary to determine compliance with local and state fire codes and federal regulation 40 CFR 112 including, but not limited to:
(i)Spill containment structures;
(ii)Control equipment to allow removal of motor fuel and rainwater from the spill containment area;
(iii)Overfill prevention devices;
(iv)Piping and valving;
(v)Atmospheric and emergency venting; and
(vi)Tank construction details.
(B)A copy of the Spill Prevention Control and Countermeasure (SPCC) Plan certified by a registered professional engineer, as required by federal regulation 40 CFR 112.
(g)Description of the UST project work including a scaled drawing (contractor’s or engineer’s drawing) showing those items and activities that are not part of a UST system but are required because of construction interference.
(h)Total project cost in the form of a bid or estimate for the proposed UST project work or the actual cost where UST project work is completed prior to filing an application under these rules. Where there is no site assessment information on possible petroleum contamination, a bid or estimate shall include the following costs for corrective action:
(A)For a facility with:
(i)One tank, include soil cleanup costs of $6,000;
(ii)Two tanks, include soil cleanup costs of $9,000;
(iii)Three tanks, include soil cleanup costs of $12,000;
(iv)Four tanks, include soil cleanup costs of $15,000;
(v)Five tanks, include soil cleanup costs of $18,000;
(vi)Six or more tanks, include soil cleanup costs of $21,000.
(B)Include groundwater cleanup costs of $25,000 for each facility where seasonal groundwater exists at ten feet or less below the surface of the ground according to available records from the Oregon Department of Water Resources, U.S. Soil Conservation Service, U.S. Geological Service, or equivalent information.
(i)For persons intending to qualify for Tiers 2, 3, and 4 financial assistance, a determination of the financial assistance ratios in section (2) of this rule by an Oregon licensed public accountant based upon the tank owner’s business or personal financial information showing all assets, income from all sources, outstanding debts and liabilities, including financial information from sole proprietors, all partners of a partnership or joint venture, corporations, and all wholly owned subsidiaries of corporations. The information furnished by the applicant to the accountant shall be adequate to allow the licensed public accountant to prepare a compiled pro forma fiscal year-end financial statement and shall include:
(A)Federal and state income tax filings for most recent fiscal year; or
(B)The most recent pro forma fiscal year-end financial statement or, where unavailable, on the most recent fiscal year, a compiled pro forma year-end financial statement prepared by a licensed public accountant.
(j)Where a UST remains in the ground and a site assessment is not part of the UST project work, the application shall include a report of the site assessment work described in OAR 340-172-0050 (Site Assessment);
(k)Insurer’s written quote; and
(l)Other information required by the Department.
(2)A licensed public accountant shall determine the following financial ratios from the information provided by the applicant in subsection (1)(i) and section (3) of this rule and definitions in Appendix 1. The calculated ratios shall be rounded upward to the nearest hundredth whole number:
(b)Debt to Equity Ratio; and
(c)Debt Service Coverage Ratio.
(3)The following estimate of liabilities associated with upgrading the USTs containing motor fuel for resale shall be added to the applicant’s compiled financial statement prior to calculation of the ratios in section (2) of this rule. For each facility for which an application is submitted for financial assistance the licensed public accountant shall add the liabilities associated with a $125,000, 5.0 percent fixed interest rate, ten year term loan. The $125,000 pro forma liability for UST project work is comprised of $35,000 for corrective action work and $90,000 for other UST project work.
Rule 340-172-0040 — Information Required on Financial Assistance Application,