Information

JB Pritzker, Governor

James A. Rivera, State Fire Marshal

Division of Petroleum & Chemical Safety

State of Illinois
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Ready Illinois
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Division of Petroleum & Chemical Safety

Facility Details

Facility Number:	4009542
Status:	Active
Facility Name:	Effingham Travel Center
Address:	1702 West Evergreen I-57, I-70 & 32/33, Exit 170 Effingham, IL 62401
County:	Effingham
Property Parcel:	035
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Z001697
Green Tag Issue Date:	1/2/2024
Green Tag Expiration Date:	12/31/2026

Owner Details

Owner Name:	HPT TA Properties, LLC
Owner Address:	24601 Center Ridge Road Westlake, OH 44145
Owner Status:	Current Owner
Purchase Date:	1/31/2007
Type of Financial Responsibility:	Commercial Insurance
Financial Responsibility Reporting Due Date:	2/28/2025

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	1/2/2024	12/31/2026

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0034157	HPT TA Properties, LLC	Current Owner	1/31/2007
U0021229	TA Operating Corporation	Former Owner	10/1/1993
U0014428	Standard Oil Co	Former Owner	12/31/1967
U0026726	TA Operating, LLC	Former Owner

Permits (Unexpired)

Click for permit history

Permit Number	Type	Status	OSFM Receive Date	Issue Date	Expiration Date	Documents
01337-2023CAT	Cathodic Protection	Approved / Issued	11/20/2023	11/20/2023	5/21/2024	Documents

Deficiencies (Current)

No Deficiencies Found

IEMA Numbers Associated with the Facility

IEMA Number	Inspection Date	Inspection Type	Permit Number
92-1403	3/30/1993	Removal Log
98-0862	4/17/1998	Removal Log

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
20210521	Eligible	4/11/2023	4/14/2023	$5,000	Letter

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	12000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	52		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	1/1/1972

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Impressed Current Cathodic Protection	4/25/2024	4/25/2025
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	12/1/2021	12/1/2024
Piping	Fiberglass Double Wall	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor	8/3/2023	8/3/2024
Spill Contain Device	Single Wall Spill Bucket	9/30/2021	9/30/2024
Tank	Steel Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	8/2/2023
Tank	Steel Single Wall	Precision Test (Tank)	Pass	8/2/2023
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	Sensor Functional	Pass	7/28/2009

Tank Number 2

Capacity:	12000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	52		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	1/1/1972

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Impressed Current Cathodic Protection	4/25/2024	4/25/2025
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	12/1/2021	12/1/2024
Piping	Fiberglass Double Wall	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor	8/3/2023	8/3/2024
Spill Contain Device	Single Wall Spill Bucket	9/30/2021	9/30/2024
Tank	Steel Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	8/2/2023
Tank	Steel Single Wall	Precision Test (Tank)	Pass	8/2/2023
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	Sensor Functional	Pass	7/28/2009

Tank Number 3

Capacity:	12000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	4/17/1998
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	26		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	10/1/1991		Fee Due:	$0.00
Product Date:	1/1/1972

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:	12000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	4/17/1998
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	26		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	10/1/1991		Fee Due:	$0.00
Product Date:	1/1/1972

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:	12000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	3/30/1993
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	21		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	3/1/1993		Fee Due:	$0.00
Product Date:	1/1/1972

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:	12000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	3/30/1993
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	21		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	3/1/1993		Fee Due:	$0.00
Product Date:	1/1/1972

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:	12000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	3/30/1993
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	21		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	3/1/1993		Fee Due:	$0.00
Product Date:	1/1/1972

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:	12000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	3/30/1993
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	21		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	3/1/1993		Fee Due:	$0.00
Product Date:	1/1/1972

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:	12000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	3/30/1993
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	21		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	3/1/1993		Fee Due:	$0.00
Product Date:	1/1/1972

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 10

Capacity:	8000		Petroleum Use:
Product:	Lube Oil		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	38		Abandoned Date:
Install Date:	1/1/1986		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	1/1/1986

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	European with No Test Req Suction	N/A	N/A
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 300 with CSLD	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	12/23/2021	12/23/2024
Piping	Fiberglass Double Wall	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	12/1/2021	12/1/2024
Tank	Fiberglass Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	8/2/2023
Tank	Fiberglass Single Wall	Precision Test (Tank)	Pass	8/2/2023

Tank Number 11

Capacity:	4000		Petroleum Use:
Product:	Used Oil		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	38		Abandoned Date:
Install Date:	1/1/1986		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	1/1/1986

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Gravity Feed	N/A	N/A
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 300 with CSLD	8/3/2023	8/3/2024
Piping	Fiberglass Double Wall	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	12/1/2021	12/1/2024
Tank	Fiberglass Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	8/2/2023
Tank	Fiberglass Single Wall	Precision Test (Tank)	Pass	8/2/2023

Tank Number 12

Capacity:	4000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	4/1/1993
OSFM First Notify Date:	5/2/1986		Abandoned Material:
Current Age:	21		Abandoned Date:
Install Date:	1/1/1972		Red Tag Issue Date:
Last Used Date:	3/1/1993		Fee Due:	$0.00
Product Date:	1/1/1972

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 13

Capacity:	1000		Petroleum Use:
Product:	Water		CERCLA Substance:
Status:	Unknown		CAS Code:
Regulated Status:	Non-Regulated		Removed Date:
OSFM First Notify Date:	11/13/1992		Abandoned Material:
Current Age:			Abandoned Date:
Install Date:			Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 14

Capacity:	20000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	6/22/1994		Abandoned Material:
Current Age:	31		Abandoned Date:
Install Date:	11/15/1992		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/15/1992

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	6/15/2022	6/15/2025
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor with positive shutdown	10/19/2021	10/19/2022
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Piping	Single Wall Transition Sump	6/30/2021	6/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor	1/10/2019	1/10/2020
Leak Detect - Piping	Non-Discriminating Sump Sensor	12/17/2020	12/17/2021
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Spill Contain Device	Single Wall Spill Bucket	9/30/2021	9/30/2024
Tank	Fiberglass Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	12/17/2020
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	Precision Test	Pass	8/2/2023
Tank	Fiberglass Single Wall	Precision Test (Tank)	Pass	8/2/2023

Tank Number 15

Capacity:	20000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	6/22/1994		Abandoned Material:
Current Age:	31		Abandoned Date:
Install Date:	11/15/1992		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/15/1992

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	6/15/2022	6/15/2025
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor with positive shutdown	10/19/2021	10/19/2022
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Piping	Single Wall Transition Sump	6/30/2021	6/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor
Leak Detect - Piping	Non-Discriminating Sump Sensor	12/17/2020	12/17/2021
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Spill Contain Device	Single Wall Spill Bucket	9/30/2021	9/30/2024
Tank	Fiberglass Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	12/17/2020
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	Precision Test	Pass	8/2/2023
Tank	Fiberglass Single Wall	Precision Test (Tank)	Pass	8/2/2023

Tank Number 16

Capacity:	20000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	6/22/1994		Abandoned Material:
Current Age:	31		Abandoned Date:
Install Date:	11/15/1992		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/15/1992

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	6/15/2022	6/15/2025
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor with positive shutdown	10/19/2021	10/19/2022
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Piping	Single Wall Transition Sump	6/30/2021	6/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor	1/10/2019	1/10/2020
Leak Detect - Piping	Non-Discriminating Sump Sensor	12/17/2020	12/17/2021
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Spill Contain Device	Single Wall Spill Bucket	9/30/2021	9/30/2024
Tank	Fiberglass Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	10/7/2021
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	Precision Test	Pass	8/2/2023
Piping	Fiberglass Single Wall Piping	Precision Test	Pass	8/2/2023
Tank	Fiberglass Single Wall	Precision Test (Tank)	Pass	8/2/2023

Tank Number 17

Capacity:	20000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	6/22/1994		Abandoned Material:
Current Age:	31		Abandoned Date:
Install Date:	11/15/1992		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/15/1992

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	6/15/2022	6/15/2025
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor with positive shutdown	10/19/2021	10/19/2022
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Piping	Single Wall Transition Sump	6/30/2021	6/30/2024
Leak Detect - Piping	Non-Discriminating Sump Sensor	1/10/2019	1/10/2020
Leak Detect - Piping	Non-Discriminating Sump Sensor	12/17/2020	12/17/2021
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Spill Contain Device	Single Wall Spill Bucket	9/30/2021	9/30/2024
Tank	Fiberglass Single Wall	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	Fiberglass Double Wall	Precision Test	Pass	10/7/2021
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	Precision Test	Pass	8/2/2023
Tank	Fiberglass Single Wall	Precision Test (Tank)	Pass	8/2/2023

Tank Number 18

Capacity:	20000		Petroleum Use:	None
Product:	B-99		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	10/12/2021		Abandoned Material:
Current Age:	2		Abandoned Date:
Install Date:	5/26/2021		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	9/13/2021

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	8/3/2023	8/3/2024
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors With Monitor	8/3/2023	8/3/2024
Overfill Prev Device	Overfill Drop Tube Valve	10/19/2021	10/19/2024
Piping	Blending Sump	6/30/2021	6/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Piping	Blending Sump	6/30/2021	6/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	6/30/2021	6/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024
Spill Contain Device	Single Wall Spill Bucket	6/30/2021	6/30/2024
Tank	Fiberglass Double Wall Containment Solutions	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Blending Sump	Precision Test	Pass	8/2/2023
Piping	Blending Sump	Precision Test	Pass	8/2/2023
Piping	Fiberglass Single Wall Piping Ameron Dualoy 3000/L	Precision Test	Pass	8/2/2023
Tank	Fiberglass Double Wall Containment Solutions	Precision Test (Tank)	Pass	8/2/2023

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 1/2S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 10M/11S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 11/12

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 11M

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 2M/3S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 3M/4S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 4M/5S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 5M/6S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 6M

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 7/8

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 7M/8S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 7S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 8M/9S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 9/10

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

Name\ID 9M/10S

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	9/30/2021	9/30/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	8/3/2023	8/3/2024

MFD Motorfuel Dispensing Forms

Facility Number	Name	City	Received Date	Letter
4009542	Effingham Travel Center	Effingham	10/12/2021	Letter Form