Division of Petroleum & Chemical Safety

 
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Facility Details

Facility Number: 2001090
Status: Closed
Facility Name: Adjustable Forms, Inc.
Address: 1 East Progress Road
Lombard, IL 60148
County: Du Page
Property Parcel:
Facility Type: Commercial / Retail
Owner Type: Private
Green Tag Decal: M005274
Green Tag Issue Date: 5/19/2011
Green Tag Expiration Date: 12/31/2013

Owner Details

Owner Name: Adjustable Forms, Inc.
Owner Address: 1 East Progress Road
Lombard, IL 60148
Owner Status: Current Owner
Purchase Date: 6/7/1982
Type of Financial Responsibility: Commercial Insurance
Financial Responsibility Reporting Due Date: 6/27/2012

Motor Fuel Dispensing Permits

No MFD Permits Found

Owner Summary

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Owner Number Owner Name Owner Status Purchase Date
U0000218 Adjustable Forms, Inc. Current Owner 6/7/1982

Permits (Unexpired)

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No Active Permits Found

Deficiencies (Current)

No Deficiencies Found

IEMA Numbers Associated with the Facility

IEMA Number Inspection Date Inspection Type Permit Number
11-1153 11/17/2011 Removal Log 01079-2011REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number Status OSFM Received Date OSFM Response Date Deductible Letter
11-1153 Eligible 12/14/2011 2/16/2012 $5,000
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Tank Information

Tank Number Capacity Product Status Regulated Status Red Tag Issued Fee Due Abandon/Removal Date
1 2000 Diesel Fuel Removed Federal $0.00 11/17/2011 - REM
2 2000 Gasoline Removed Federal $0.00 11/17/2011 - REM

Dispenser Information

Name\ID Status

MFD Motorfuel Dispensing Forms

No Forms Found