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r_- Everett Fire Deparmtent - Fire Marshal's Office <br /> 2930 Wetmore Avenue Everett WA 98201-7th Floor <br /> PH. (425) 257.8120 FAX(425) 257-8139 www.everettfire.org <br /> Tank Decommissioning Report <br /> Permit Number: TANK2311-001 <br /> This report Is required to be completed by the current holder of an ICC UST Decommissioning Certificate who conducted or <br /> directly supervised the decommissioning work. <br /> Decommissioner's Name Nathan Montgomery <br /> Firm's Name_Filco Company_, Inc. <br /> Decommissioner's Mailing Address PO Box 31228 Seattle.WA 98103 <br /> ICC Underground Storage Tank Decommissioning Certification number: 5050940 <br /> Address of Property Where Tank is located <br /> Address 4202 Terrace Drive city Everett, WA zip-02-0-3-- <br /> Approximate <br /> ip98203Approximate Size of the Tank or Dimensions: 300 gallon___ Approximate Age of Tank:. 20 years <br /> Last Known Contents of the Tank: Heating OI I <br /> Date of Decommissioning; March 13th, 2024 <br /> Type of Decommissioning: <br /> Removal <br /> Abandonment in Place <br /> ❑ Removed and Replaced with a New Tank <br /> Date of Pump and Rinse: March 13th, 2024 <br /> Disposal Location(s): Seattle Iron & Metal and Emerald Services <br /> If Abandoned,Specify Type of Inert Fill Material: <br /> ®Concrete Slurry O Other Inert Material(Specify) <br /> ®Sand © Foam <br /> Soil contamination observed: <br /> Recommendation <br /> Location of Tank:. Facing house_ri ht side yard (North) 22" N., & 90" W. off the front of house <br /> Decommissioner's Signature:. <br /> When report completed,please scan and email reporf to:frno@evereffwa.gov <br /> RFV 6 20 1:3 Tank Decommission Reporl <br />