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STATE AUTHORIZATION <br />The Department of Environmental Management finds $ of the claim underlying <br />this Request to be eligible SRF Costs to be disbursed as directed below. <br />The Program Representative hereby (i) authorizes Bank One Trust Company, NA, as trustee, to <br />disburse the amount stated in the preceding sentence and (ii) directs that such amount be mailed <br />to: <br /> <br /> <br />the Contractor at the address identified on page 2. <br />the Qualified Entity at the address identified on page 2. <br />DEPARTMENT OF ENVIRONMENTAL PROGRAM REPRESENTATIVE <br />MANAGEMENT <br />By: By: <br />Date: <br />Date: <br />Trustee Certification <br />The undersigned, on behalf of Bank One Trust Company, NA, as trustee, hereby certifies that a <br />Disbursement in the amount authorized by the State, together with a completed copy of this <br />Request, was mailed on , 199_ to the party stated under "State Authorization" <br />above. Further, a copy of this completed Request has been mailed to the Qualified Entity and the <br />Department of Environmental Management. <br />Bank One Trust Company, NA, as Trustee <br />Date: <br />By: <br />Authorized Officer <br />430848 A-3 <br />