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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:	4016562
Status:	Closed
Facility Name:	Andy and Associates, Inc.
Address:	606 North Clinton Street Bloomington, IL 61701
County:	McLean
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	G001097
Green Tag Issue Date:	7/5/2005
Green Tag Expiration Date:	12/31/2008

Owner Details

Owner Name:	Mohammad Samhan
Owner Address:	413 Churchill Gurnee, IL 60031
Owner Status:	Current Owner
Purchase Date:	12/21/2006
Type of Financial Responsibility:
Financial Responsibility Reporting Due Date:

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	9/28/2005	12/31/2007

Owner Summary

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Owner Number	Owner Name	Owner Status	Purchase Date
U0033921	Samhan, Mohammad	Current Owner	12/21/2006
U0021517	Freedom Oil Company	Former Owner	8/4/1997
U0027450	PTJR, Inc.	Former Owner	11/1/1987
U0005453	Arnold Owens, Inc., d/b/a Freedom Oil	Former Owner	12/31/1967

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
10-1050	10/20/2010	Removal Log	01122-2010REM
10-1050	10/21/2010	Removal Log	01122-2010REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
10-1050	Eligible	9/30/2010	11/23/2010	$5,000

Pay Tank Fees Online

Tank Information

Tank Number	Capacity	Product	Status	Regulated Status	Red Tag Issued	Fee Due	Abandon/Removal Date
1	6000	Gasoline	Removed	Federal		$0.00	10/20/2010 - REM
2	6000	Diesel Fuel	Removed	Federal		$0.00	10/21/2010 - REM
3	6000	Gasoline	Removed	Federal		$0.00	10/20/2010 - REM

Dispenser Information

Name\ID	Status

MFD Motorfuel Dispensing Forms

No Forms Found