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4VEverett Fire ®eparmtent a Fire Marshal's Office <br /> � 2930 Wetmore Avenue Everett WA 98201- 7th Floor <br /> M37 <br /> V <br /> PH. (425) 257-8120 FAX (425) 257-8139 www.everettfire-org <br /> Tank Decommissioning Report <br /> Permit Number:TANK2410-002 <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 718 Rucker Ave Everett, WA 98201 <br /> Address718 Rucker Ave CityEverett, WA Zip98201 <br /> Approximate Size of the Tank or Dimensions;675 gallon Approximate Age of Tank:20+ years <br /> Last Known Contents of the Tank:Heating oil <br /> Date of Decommissioning: November 26th, 2024 <br /> Type of Decommissioning: <br /> 1-1 Removal <br /> aAbandonment in Place <br /> ❑ Removed and Replaced with a New Tank <br /> Date of Pump and Rinse:November 26th, 2024 <br /> Disposal Location(s): <br /> If Abandoned,Specify Type of Inert Fill Material: <br /> ® Concrete Slurry O Other Inert Material (Specify): <br /> 0 Sand O Foam <br /> Soil contamination observed: <br /> Recommendation: <br /> Location of Tank:Back yard between back patio and deck 49"west off back of house <br /> Decommissioner's Signature: JUGJtYIGiw "-"Jc O <br /> When report completed,please scan and email report to:fmoQeverettwa.gov <br /> REV.6,20.13 Tank Decommission Report <br />