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:	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

Click for Facility/Tank Ownership history

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)

Click for permit history

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

Pay Tank Fees Online

Tank Information

Tank Number 3

Capacity:	4000		Petroleum Use:
Product:	Gasoline - Non Ethanol		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	3/9/1989		Abandoned Material:
Current Age:	35		Abandoned Date:
Install Date:	3/25/1989		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	3/25/1989

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	6/21/2022	6/21/2025
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	11/15/2023	11/15/2024
Leak Detect - Tank	Automatic Tank Gauging Gilbarco EMC with CSLD	11/15/2023	11/15/2024
Overfill Prev Device	Overfill Drop Tube Valve	10/6/2021	10/6/2024
Piping	Flex Connector Steel	N/A	N/A
Piping	Fiberglass Single Wall Piping	N/A	N/A
Piping	Not Installed STP/Tanktop Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	10/6/2021	10/6/2024
Tank	Fiberglass Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Single Wall Piping	Precision Test	Fail	11/15/2023

Tank Number 4

Capacity:	4000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	3/9/1989		Abandoned Material:
Current Age:	35		Abandoned Date:
Install Date:	3/25/1989		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	3/25/1989

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	6/21/2022	6/21/2025
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	11/15/2023	11/15/2024
Leak Detect - Tank	Automatic Tank Gauging Gilbarco EMC with CSLD	11/15/2023	11/15/2024
Overfill Prev Device	Overfill Drop Tube Valve	10/6/2021	10/6/2024
Piping	Flex Connector Steel	N/A	N/A
Piping	Fiberglass Single Wall Piping	N/A	N/A
Piping	Not Installed STP/Tanktop Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	10/6/2021	10/6/2024
Tank	Fiberglass Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Single Wall Piping	Precision Test	Pass	11/15/2023

Tank Number 5

Capacity:	4000		Petroleum Use:	None
Product:	Kerosene		CERCLA Substance:
Status:	Abandoned in place		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	3/9/1989		Abandoned Material:	Inert material mixed with portland cement
Current Age:	35		Abandoned Date:	12/3/2019
Install Date:	3/25/1989		Red Tag Issue Date:
Last Used Date:	11/30/2018		Fee Due:	$0.00
Product Date:	3/25/1989

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	9/27/2018	9/27/2021
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	10/10/2017	9/27/2018
Leak Detect - Tank	Automatic Tank Gauging Gilbarco EMC with CSLD	9/27/2018	9/27/2019
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Flex Connector Steel	N/A	N/A
Piping	Fiberglass Single Wall Piping	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	9/27/2018	9/27/2021
Tank	Fiberglass Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 6

Capacity:	10000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/5/1986		Abandoned Material:
Current Age:	46		Abandoned Date:
Install Date:	5/6/1978		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	5/6/1978

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	6/21/2022	6/21/2025
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal Bridgeport Chemical Glass Armor GA 27P	11/14/2023	11/14/2028
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	11/15/2023	11/15/2024
Leak Detect - Tank	Automatic Tank Gauging Gilbarco EMC with CSLD	11/15/2023	11/15/2024
Overfill Prev Device	Overfill Drop Tube Valve	10/6/2021	10/6/2024
Piping	Flex Connector Steel	N/A	N/A
Piping	Fiberglass Single Wall Piping	N/A	N/A
Piping	Not Installed STP/Tanktop Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	10/6/2021	10/6/2024
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Single Wall Piping	Precision Test	Pass	11/15/2023
Tank	Steel Single Wall	Precision Test (Tank)	Pass	11/15/2023

Tank Number 7

Capacity:	10000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/5/1986		Abandoned Material:
Current Age:	46		Abandoned Date:
Install Date:	5/6/1978		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	5/6/1978

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	6/21/2022	6/21/2025
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal Bridgeport Chemical Glass Armor GA 27P	11/14/2023	11/14/2028
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	11/15/2023	11/15/2024
Leak Detect - Tank	Automatic Tank Gauging Gilbarco EMC with CSLD	11/15/2023	11/15/2024
Overfill Prev Device	Overfill Drop Tube Valve	10/6/2021	10/6/2024
Piping	Flex Connector Steel	N/A	N/A
Piping	Fiberglass Single Wall Piping	N/A	N/A
Piping	Not Installed STP/Tanktop Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	10/6/2021	10/6/2024
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Single Wall Piping	Precision Test	Pass	11/15/2023
Tank	Steel Single Wall	Precision Test (Tank)	Pass	11/15/2023

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

Name\ID 11/12

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

Name\ID 7/8

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

Name\ID 9/10/

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

MFD Motorfuel Dispensing Forms

No Forms Found