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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:	4034774
Status:	Active
Facility Name:	Casey's General Store #1903
Address:	1700 W. Main Street Shelbyville, IL 62565
County:	Shelby
Property Parcel:	1812-12-19-402-009
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Y000837
Green Tag Issue Date:	3/15/2023
Green Tag Expiration Date:	12/31/2025

Owner Details

Owner Name:	Casey's Retail Company
Owner Address:	3305 SE Delaware Ave. P.O. Box 3004 Ankeny, IA 50021
Owner Status:	Current Owner
Purchase Date:	6/6/1996
Type of Financial Responsibility:	Self-Insurance
Financial Responsibility Reporting Due Date:	10/27/2024

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	3/15/2023	12/31/2025

Owner Summary

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Owner Number	Owner Name	Owner Status	Purchase Date
U0002560	Casey's Retail Company	Current Owner	6/6/1996

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
2022-1017	11/16/2022	Removal Log	01108-2022REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
20221017	Eligible	2/9/2023	2/16/2023	$5,000	Letter

Pay Tank Fees Online

Tank Information

Tank Number	Capacity	Product	Status	Regulated Status	Red Tag Issued	Fee Due	Abandon/Removal Date
1	10000	Gasoline - Regular	Removed	Federal		$0.00	11/16/2022 - REM
2	10000	Diesel Fuel	Removed	Federal		$0.00	11/16/2022 - REM
3	14000	Gasoline - Regular	Currently in use	Federal		$0.00
4	14000	Diesel Fuel	Currently in use	Federal		$0.00
5	8000	Gasoline - Premium	Currently in use	Federal		$0.00
6	8000	E15	Currently in use	Federal		$0.00

Dispenser Information

Name\ID	Status
1/2	Active
3/4	Active
5/6	Active
7/8	Active

MFD Motorfuel Dispensing Forms

Facility Number	Name	City	Received Date	Letter
4034774	Casey's General Store #1903	Shelbyville	02/13/2023	Letter Form