Section 807.APPENDIX A Financial Assurance Forms

Section 807.ILLUSTRATION G Owner's or Operator's Bond Without Surety

Owner's or Operator's Bond Without Surety

Date bond executed:
Effective date:
Owner or Operator:
Owner's or Operator's address:

Site:
Site address:

Penal Sum:		$

The owner or operator promises to pay the penal sum to the Illinois Environmental Protection Agency unless the owner or operator provides closure and post-closure care of the site in accordance with the closure and post-closure care plans for the site.

Owner or Operator

Signature

Typed Name

Title

Date

Corporate Seal

(Source: Amended at 35 Ill. Reg. 10784, effective June 22, 2011)