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Case Closure Suumtary <br />Leake Underground Fuel Storage Tank ogram <br />I Agency Information if, �•+ Date: <br />Agency name: <br />Address: <br />City/State/Zip: <br />Phone: <br />Responsible staff person: <br />Title: <br />II. Case Information <br />Site facility name: ;i <br />Site facility address: j1 <br />RB LIISTIS Case No: Local Case No: LOP Case No: <br />IIRF filing data: SWEEPS No: <br />Ir <br />Responsible Parties Addresses k Phone Numbers <br />!� s <br />i{ <br />I; <br />Tank No Size in Gal. Contents Closed in-Place/Removed? iDate <br />�f <br />1 !� <br />2 <br />E3_ <br />111. Release and Site Characterization Information i. <br />Cause and type of release: <br />Site characterization complete? Yes No Date approved by oversight agency: <br />Monitoring Wells Installed? Yes No Number: Prloper''screen interval? Yes No <br />Highest Gw depth below ground surface: Lowest depth: <br />Flow direction: <br />Most Sensitive Current Use: <br />Are drinking water wells affected? Yes No Aquiferk name: <br />Is surface water affected? Yes No Nearest/affected SW name: <br />off-site beneficial use impacts (addresses/locaticnsY: <br />Report(s) on file? Yes No where is report(s) filed?' <br />Treatment and Disposal of Affected Material �} <br />Material Amt. (inc. IInits) Action (Treatment or Disposal w/Destination Date <br />Tank <br />Piping <br />Free Product <br />Soil <br />Groundwater <br />Barrels I is <br />Exhibit N page 1 of 2 <br />t <br />4 <br />0 <br />