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

Facility Details

Facility Number:	4008000
Status:	Active
Facility Name:	Jack Flash
Address:	1200 North Keller Drive Effingham, IL 62401
County:	Effingham
Property Parcel:	03-11-018-115
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Z001723
Green Tag Issue Date:	3/26/2024
Green Tag Expiration Date:	12/31/2026

Owner Details

Owner Name:	Wortman Development, LLC
Owner Address:	P.O. Box 217 1301 Mansfield Drive Effingham, IL 62401
Owner Status:	Current Owner
Purchase Date:	2/3/2021
Type of Financial Responsibility:	Self-Insurance
Financial Responsibility Reporting Due Date:	6/29/2024

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	3/26/2024	12/31/2026

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0040172	Wortman Development, LLC	Current Owner	2/3/2021
U0033182	Wortman-Keller Development, LLC	Former Owner	11/1/2005
U0033182	Wortman-Keller Development, LLC	Former Owner	8/25/2005
U0033182	Wortman-Keller Development, LLC	Former Owner
U0032717	Wortman-Meyer Properties, LLC	Former Owner
U0008722	L. Keller Oil Properties, Inc.	Former Owner

Permits (Unexpired)

Click for permit history

No Active Permits Found

Deficiencies (Current)

No Deficiencies Found

IEMA Numbers Associated with the Facility

IEMA Number	Inspection Date	Inspection Type	Permit Number
05-0206	4/5/2005	Removal Log	00051-2005REM
05-0690	5/27/2005	Removal Log	00512-2005REM
99-2274	3/6/2000	Removal Log	03510-1999REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
99-2274	Eligible	4/18/2000	5/4/2000	$10,000
05-0690	Eligible	8/4/2005	8/24/2005	$15,000
05-0206	Eligible	9/9/2005	9/26/2005	$15,000

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	12000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	4/5/2005
OSFM First Notify Date:	4/20/1986		Abandoned Material:
Current Age:	23		Abandoned Date:
Install Date:	4/24/1982		Red Tag Issue Date:
Last Used Date:	4/4/2005		Fee Due:	$0.00
Product Date:	4/24/1982

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 2

Capacity:	12000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	4/5/2005
OSFM First Notify Date:	4/20/1986		Abandoned Material:
Current Age:	23		Abandoned Date:
Install Date:	4/24/1982		Red Tag Issue Date:
Last Used Date:	4/4/2005		Fee Due:	$0.00
Product Date:	4/24/1982

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 3

Capacity:	8000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	3/6/2000
OSFM First Notify Date:	4/20/1986		Abandoned Material:
Current Age:	17		Abandoned Date:
Install Date:	4/24/1982		Red Tag Issue Date:
Last Used Date:	12/21/1998		Fee Due:	$0.00
Product Date:	4/24/1982

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 4

Capacity:	6000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	3/6/2000
OSFM First Notify Date:	4/20/1986		Abandoned Material:
Current Age:	33		Abandoned Date:
Install Date:	6/10/1966		Red Tag Issue Date:
Last Used Date:	12/21/1998		Fee Due:	$0.00
Product Date:	6/10/1966

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 5

Capacity:	500		Petroleum Use:
Product:	Used Oil		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	4/24/1987
OSFM First Notify Date:	4/20/1986		Abandoned Material:
Current Age:	20		Abandoned Date:
Install Date:	6/10/1966		Red Tag Issue Date:
Last Used Date:	4/24/1985		Fee Due:	$0.00
Product Date:	6/10/1966

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 6

Capacity:	6000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	5/27/2005
OSFM First Notify Date:	5/19/2005		Abandoned Material:
Current Age:	38		Abandoned Date:
Install Date:	6/10/1966		Red Tag Issue Date:
Last Used Date:	4/24/1987		Fee Due:	$0.00
Product Date:	6/10/1966

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 7

Capacity:	4000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	5/27/2005
OSFM First Notify Date:	5/19/2005		Abandoned Material:
Current Age:	38		Abandoned Date:
Install Date:	6/10/1966		Red Tag Issue Date:
Last Used Date:	4/24/1987		Fee Due:	$0.00
Product Date:	6/10/1966

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 8

Capacity:	6000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	5/27/2005
OSFM First Notify Date:	5/19/2005		Abandoned Material:
Current Age:	38		Abandoned Date:
Install Date:	6/10/1966		Red Tag Issue Date:
Last Used Date:	4/24/1987		Fee Due:	$0.00
Product Date:	6/10/1966

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 9

Capacity:	15000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	11/29/2005		Abandoned Material:
Current Age:	18		Abandoned Date:
Install Date:	8/25/2005		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/4/2005

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Composite Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	11/30/2023	11/30/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	11/30/2023	11/30/2024
Overfill Prev Device	Overfill Drop Tube Valve	6/8/2022	6/8/2025
Piping	Flexible Double Wall A.P.T. Poly Tech	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	8/17/2022	8/17/2025
Leak Detect - Piping	Sump Sensor	12/15/2021	12/15/2022
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024
Spill Contain Device	Single Wall Spill Bucket	6/8/2022	6/8/2025
Tank	Composite Single Wall ACT 100	N/A	N/A
Vent, Riser, Fill Piping	Steel risers	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech	Precision Test	Pass	11/30/2023

Tank Number 10

Capacity:	8000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	11/29/2005		Abandoned Material:
Current Age:	18		Abandoned Date:
Install Date:	8/25/2005		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/4/2005

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Composite Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	11/30/2023	11/30/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	11/30/2023	11/30/2024
Overfill Prev Device	Overfill Drop Tube Valve	6/8/2022	6/8/2025
Piping	Flexible Double Wall A.P.T. Poly Tech	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor	12/15/2021	12/15/2022
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024
Spill Contain Device	Single Wall Spill Bucket	6/8/2022	6/8/2025
Tank	Composite Single Wall ACT 100	N/A	N/A
Vent, Riser, Fill Piping	Steel risers	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech	Precision Test	Pass	11/30/2023

Tank Number 11

Capacity:	8000		Petroleum Use:
Product:	B-11		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	11/29/2005		Abandoned Material:
Current Age:	18		Abandoned Date:
Install Date:	8/25/2005		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/4/2005

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Composite Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	11/30/2023	11/30/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	11/30/2023	11/30/2024
Overfill Prev Device	Overfill Drop Tube Valve	6/8/2022	6/8/2025
Piping	Flexible Double Wall A.P.T. Poly Tech	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor	12/15/2021	12/15/2022
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024
Spill Contain Device	Single Wall Spill Bucket	6/8/2022	6/8/2025
Tank	Composite Single Wall ACT 100	N/A	N/A
Vent, Riser, Fill Piping	Steel risers	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech	Precision Test	Pass	11/30/2023

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 11/12

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	3/13/2024	3/13/2027
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 13/14

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 15/16

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 17/18

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 19/20

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 7/8

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/8/2022	6/8/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

Name\ID 9/10

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	3/13/2024	3/13/2027
Leak Detect - Piping	Sump Sensor with positive shutdown	11/30/2023	11/30/2024

MFD Motorfuel Dispensing Forms

No Forms Found