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:	4021707
Status:	Active
Facility Name:	Clark
Address:	615 N. Cedar Shelbyville, IL 62565
County:	Shelby
Property Parcel:	2013-07-13-301-001
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Y000825
Green Tag Issue Date:	3/1/2023
Green Tag Expiration Date:	12/31/2025

Owner Details

Owner Name:	Shyam Food Mart, Inc.
Owner Address:	615 N. Cedar Shelbyville, IL 62565
Owner Status:	Current Owner
Purchase Date:	6/27/2014
Type of Financial Responsibility:	Certificate of Deposit
Financial Responsibility Reporting Due Date:	9/13/2023

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	3/1/2023	12/31/2025

Owner Summary

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Owner Number	Owner Name	Owner Status	Purchase Date
U0037897	Shyam Food Mart, Inc.	Current Owner	6/27/2014
U0026775	Lincoln Land Oil Company	Former Owner	12/5/1986
U0017119	Chronister Oil Company	Former Owner

Permits (Unexpired)

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No Active Permits Found

Deficiencies (Current)

No Deficiencies Found

IEMA Numbers Associated with the Facility

No IEMA Numbers Found

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
20191157	Eligible	1/9/2020	1/15/2020	$5,000	Letter

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Tank Information

Tank Number	Capacity	Product	Status	Regulated Status	Red Tag Issued	Fee Due	Abandon/Removal Date
3	4000	Gasoline - Non Ethanol	Currently in use	Federal		$0.00
4	4000	Diesel Fuel	Currently in use	Federal		$0.00
5	4000	Kerosene	Abandoned in place	Federal		$0.00	12/03/2019 - ABN
6	10000	Gasoline - Premium	Currently in use	Federal		$0.00
7	10000	Gasoline - Regular	Currently in use	Federal		$0.00

Dispenser Information

Name\ID	Status
1/2	Active
3/4	Active
5/6	Active
7/8	Active
9/10/	Active
11/12	Active

MFD Motorfuel Dispensing Forms

No Forms Found