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

Facility Details

Facility Number:	4044787
Status:	Closed
Facility Name:	Jerry Self
Address:	12th & Main Casey, IL 62420
County:	Clark
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:
Green Tag Issue Date:
Green Tag Expiration Date:

Owner Details

Owner Name:	Jerry Self
Owner Address:	5 NE 13th Street Casey, IL 62420
Owner Status:	Current Owner
Purchase Date:
Type of Financial Responsibility:	Letter of Credit
Financial Responsibility Reporting Due Date:	10/1/2011

Motor Fuel Dispensing Permits

No MFD Permits Found

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0035903	Self, Jerry	Current Owner

Permits (Unexpired)

Click for permit history

No Active Permits Found

Deficiencies (Current)

No Deficiencies Found

IEMA Numbers Associated with the Facility

IEMA Number	Inspection Date	Inspection Type	Permit Number
10-1115	10/28/2010	Removal Log	01189-2010REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
10-1115	Eligible	11/9/2010	12/20/2010	$5,000

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	550		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	10/28/2010
OSFM First Notify Date:	10/1/2010		Abandoned Material:
Current Age:	50		Abandoned Date:
Install Date:	1/1/1960		Red Tag Issue Date:
Last Used Date:	1/1/1975		Fee Due:	$0.00
Product Date:	1/1/1960

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 2

Capacity:	550		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	10/28/2010
OSFM First Notify Date:	10/1/2010		Abandoned Material:
Current Age:	50		Abandoned Date:
Install Date:	1/1/1960		Red Tag Issue Date:
Last Used Date:	1/1/1975		Fee Due:	$0.00
Product Date:	1/1/1960

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Dispenser Information

MFD Motorfuel Dispensing Forms

No Forms Found