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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
Facility Details
Facility Number:
4016902
Status:
Closed
Facility Name:
Jack Flash Food Plaza
Address:
1207-B N. Keller Drive
Effingham, IL 62401
County:
Effingham
Property Parcel:
Facility Type:
Attended Self-Service Station
Owner Type:
Private
Green Tag Decal:
O003174
Green Tag Issue Date:
7/29/2013
Green Tag Expiration Date:
12/31/2015
Owner Details
Owner Name:
Wortman-Keller Development, LLC
Owner Address:
1301 Mansfield Dr.
P.O. Box 217
Effingham, IL 62401
Owner Status:
Current Owner
Purchase Date:
9/21/2012
Type of Financial Responsibility:
Self-Insurance
Financial Responsibility Reporting Due Date:
5/9/2015
Motor Fuel Dispensing Permits
MFD Permit Type
Issue Date
Expiration Date
Self Service
7/29/2013
12/31/2015
Owner Summary
Click for Facility/Tank Ownership history
Owner Number
Owner Name
Owner Status
Purchase Date
U0033182
Wortman-Keller Development, LLC
Current Owner
9/21/2012
U0036467
Aving-Rice, LLC
Former Owner
2/23/2012
U0033415
SNC JJ Effingham IV, LLC
Former Owner
4/10/2006
U0017339
Niebrugge Oil Company
Former Owner
4/1/1989
U0011864
Phillips Petroleum Company
Former Owner
12/31/1967
U0036615
Wortman-Keller Development, LLC
Former Owner
Permits (Unexpired)
Click for permit history
No Active Permits Found
Notice of Violations (Current)
No Notice of Violations Found
IEMA Numbers Associated with the Facility
IEMA Number
Inspection Date
Inspection Type
Permit Number
14-1181
11/26/2014
Removal Log
01024-2014REM
LUST
Fund Eligibility and Deductibility Determinations
IEMA Number
Status
OSFM Received Date
OSFM Response Date
Deductible
Letter
13-0192
Eligible
4/1/2013
5/21/2013
$5,000
14-1181
Eligible
10/23/2014
12/22/2014
$5,000
Pay Tank Fees Online
Tank Information
Tank Number 5
Capacity:
10000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
11/26/2014
OSFM
First Notify Date:
3/15/1994
Abandoned Material:
Current Age:
25
Abandoned Date:
Install Date:
4/15/1989
Red Tag Issue Date:
Last Used Date:
2/28/2013
Fee Due:
$0.00
Product Date:
4/15/1989
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Corrosion Prot - Piping
Impressed Current Cathodic Protection
10/3/2013
10/3/2014
Corrosion Prot - Tank
Impressed Current Cathodic Protection
10/3/2013
10/3/2014
Leak Detect - Piping
Mechanical Pressurized Line Leak Detection
10/3/2013
10/3/2014
Leak Detect - Tank
Automatic Tank Gauging Veeder Root TLS 350
Overfill Prev Device
Ball Float Vent Valve
Piping
Fiberglass Single Wall Piping
N/A
N/A
Spill Contain Device
Single Wall Spill Bucket
Tank
Steel Single Wall
N/A
N/A
Vent, Riser, Fill Piping
Steel risers
N/A
N/A
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 6
Capacity:
10000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
11/26/2014
OSFM
First Notify Date:
3/15/1994
Abandoned Material:
Current Age:
25
Abandoned Date:
Install Date:
4/15/1989
Red Tag Issue Date:
Last Used Date:
10/16/2014
Fee Due:
$0.00
Product Date:
4/15/1989
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Corrosion Prot - Piping
Impressed Current Cathodic Protection
10/3/2013
10/3/2014
Corrosion Prot - Tank
Impressed Current Cathodic Protection
10/3/2013
10/3/2014
Leak Detect - Piping
Mechanical Pressurized Line Leak Detection
10/3/2013
10/3/2014
Leak Detect - Tank
Automatic Tank Gauging Veeder Root TLS 350
Overfill Prev Device
Ball Float Vent Valve
Piping
Fiberglass Single Wall Piping
N/A
N/A
Spill Contain Device
Single Wall Spill Bucket
Tank
Steel Single Wall
N/A
N/A
Vent, Riser, Fill Piping
Steel risers
N/A
N/A
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 7
Capacity:
10000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
11/26/2014
OSFM
First Notify Date:
3/15/1994
Abandoned Material:
Current Age:
25
Abandoned Date:
Install Date:
4/15/1989
Red Tag Issue Date:
Last Used Date:
10/16/2014
Fee Due:
$0.00
Product Date:
4/15/1989
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Corrosion Prot - Piping
Impressed Current Cathodic Protection
10/3/2013
10/3/2014
Corrosion Prot - Tank
Impressed Current Cathodic Protection
10/3/2013
10/3/2014
Leak Detect - Piping
Mechanical Pressurized Line Leak Detection
10/3/2013
10/3/2014
Leak Detect - Tank
Automatic Tank Gauging Veeder Root TLS 350
Overfill Prev Device
Ball Float Vent Valve
Piping
Fiberglass Single Wall Piping
N/A
N/A
Spill Contain Device
Single Wall Spill Bucket
Tank
Steel Single Wall
N/A
N/A
Vent, Riser, Fill Piping
Steel risers
N/A
N/A
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 8
Capacity:
6000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
6/27/1989
OSFM
First Notify Date:
4/16/1986
Abandoned Material:
Current Age:
33
Abandoned Date:
Install Date:
Red Tag Issue Date:
Last Used Date:
10/1/1977
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 9
Capacity:
560
Petroleum Use:
Product:
Used Oil
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
1/1/1980
OSFM
First Notify Date:
4/16/1986
Abandoned Material:
Current Age:
33
Abandoned Date:
Install Date:
Red Tag Issue Date:
Last Used Date:
10/1/1977
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 10
Capacity:
6000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
6/27/1989
OSFM
First Notify Date:
4/16/1986
Abandoned Material:
Current Age:
33
Abandoned Date:
Install Date:
Red Tag Issue Date:
Last Used Date:
10/1/1977
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 11
Capacity:
1000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
1/1/1980
OSFM
First Notify Date:
4/16/1986
Abandoned Material:
Current Age:
33
Abandoned Date:
Install Date:
Red Tag Issue Date:
Last Used Date:
10/1/1977
Fee Due:
$0.00
Product Date:
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
