Information

JB Pritzker, Governor

James A. Rivera, State Fire Marshal

Division of Petroleum & Chemical Safety

State of Illinois
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Division of Petroleum & Chemical Safety

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Facility Details

Facility Number:	2010521
Status:	Closed
Facility Name:	Former P.G. Clark
Address:	5 W. Palatine Road Palatine, IL 60067
County:	Cook
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	K000919
Green Tag Issue Date:	7/23/2009
Green Tag Expiration Date:	12/31/2011

Owner Details

Owner Name:	Village of Palatine
Owner Address:	200 E. Wood Street Palatine, IL 60067
Owner Status:	Current Owner
Purchase Date:	4/19/2011
Type of Financial Responsibility:	Self-Insurance
Financial Responsibility Reporting Due Date:	4/25/2012

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	5/19/2009	12/31/2011

Owner Summary

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Owner Number	Owner Name	Owner Status	Purchase Date
U0011498	Village of Palatine	Current Owner	4/19/2011
U0028012	ZBJ Inc	Former Owner	4/16/1998
U0025981	Pdv Midwest Refining Llc	Former Owner	5/1/1997
U0015441	The Uno Ven Company	Former Owner	9/21/1994
U0030698	Nida Saba, Inc.,	Former Owner
U0029182	Palatine Citgo	Former Owner

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
11-1144	10/24/2011	Removal Log	00995-2011REM
15-1246	11/30/2015	Removal Log	01255-2015REM
902055	7/24/1990	Removal Log

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
95-0010	Returned	2/19/1997	2/19/1997	$10,000
11-1144	Eligible	6/5/2012	8/2/2012	$5,000
15-1246	Eligible	1/27/2016	3/10/2016	$5,000

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Tank Information

Tank Number	Capacity	Product	Status	Regulated Status	Red Tag Issued	Fee Due	Abandon/Removal Date
1	550	Used Oil	Removed	Federal		$0.00	07/01/1990 - REM
2	1000	Heating Oil	Removed	State		$0.00	07/01/1990 - REM
3	4000	Gasoline	Removed	Federal		$0.00	10/24/2011 - REM
4	6000	Gasoline	Removed	Federal		$0.00	10/24/2011 - REM
5	6000	Gasoline	Removed	Federal		$0.00	10/24/2011 - REM
6	550	Used Oil	Removed	Federal		$0.00	11/30/2015 - REM
7	550	Used Oil	Removed	Federal		$0.00	11/30/2015 - REM

Dispenser Information

Name\ID	Status

MFD Motorfuel Dispensing Forms

No Forms Found