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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: 4046489
Status: Active
Facility Name: Casey's General Store # 3646
Address: 111 East Cox Street
Forsyth, IL 62535
County: Macon
Property Parcel: 07-07-14-153-001
Facility Type: Attended Self-Service Station
Owner Type: Private
Green Tag Decal: Z002127
Green Tag Issue Date: 12/9/2024
Green Tag Expiration Date: 12/31/2026

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: 10/16/2017
Type of Financial Responsibility: Self-Insurance
Financial Responsibility Reporting Due Date: 10/27/2025

Motor Fuel Dispensing Permits

MFD Permit Type Issue Date Expiration Date
Self Service 12/9/2024 12/31/2026

Owner Summary

Click for Facility/Tank Ownership history
Owner Number Owner Name Owner Status Purchase Date
U0002560 Casey's Retail Company Current Owner 10/16/2017

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

No IEMA Numbers Found

LUST Fund Eligibility and Deductibility Determinations

No Applications Found

Pay Tank Fees Online

Tank Information



Tank Number 1

Capacity: 22000 Petroleum Use:
Product: Gasoline - Regular CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 1/10/2018 Abandoned Material:
Current Age: 7 Abandoned Date:
Install Date: 10/16/2017 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/14/2017

Equipment

Equipment Type Equipment Last Passing Date Test Expire Date
Corrosion Prot - Piping Flexible Non-Corrosive N/A N/A
Corrosion Prot - Tank Fiberglass Non-Corrosive N/A N/A
Leak Detect - Piping Electronic Pressurized Line Leak Detection 1/7/2025 1/7/2026
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD 1/7/2025 1/7/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 1/7/2025 1/7/2026
Overfill Prev Device Overfill Drop Tube Valve 1/12/2024 1/12/2027
Piping Flexible Double Wall A.P.T. Poly Tech S175SC N/A N/A
Piping Single Wall STP/Tanktop Sump 2/7/2024 2/7/2027
Leak Detect - Piping Discriminating Sump Sensor with positive shutdown 1/14/2021 1/14/2022
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026
Piping Single Wall STP/Tanktop Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026
Spill Contain Device Single Wall Spill Bucket 2/7/2024 2/7/2027
Tank Fiberglass Double Wall Containment Solutions N/A N/A

Additional Tests

Equipment Type Equipment Test Type Test Result Test Date



Tank Number 2

Capacity: 14000 Petroleum Use:
Product: Diesel Fuel CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 1/10/2018 Abandoned Material:
Current Age: 7 Abandoned Date:
Install Date: 10/16/2017 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/14/2017

Equipment

Equipment Type Equipment Last Passing Date Test Expire Date
Corrosion Prot - Piping Flexible Non-Corrosive N/A N/A
Corrosion Prot - Tank Fiberglass Non-Corrosive N/A N/A
Leak Detect - Piping Electronic Pressurized Line Leak Detection 1/7/2025 1/7/2026
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD 1/7/2025 1/7/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 1/7/2025 1/7/2026
Overfill Prev Device Overfill Drop Tube Valve 1/12/2024 1/12/2027
Piping Flexible Double Wall A.P.T. Poly Tech S175SC N/A N/A
Piping Single Wall STP/Tanktop Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026
Spill Contain Device Single Wall Spill Bucket 2/7/2024 2/7/2027
Tank Fiberglass Double Wall Containment Solutions N/A N/A

Additional Tests

Equipment Type Equipment Test Type Test Result Test Date



Tank Number 3

Capacity: 8000 Petroleum Use:
Product: Gasoline - Premium CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 1/10/2018 Abandoned Material:
Current Age: 7 Abandoned Date:
Install Date: 10/16/2017 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/14/2017

Equipment

Equipment Type Equipment Last Passing Date Test Expire Date
Corrosion Prot - Piping Flexible Non-Corrosive N/A N/A
Corrosion Prot - Tank Fiberglass Non-Corrosive N/A N/A
Leak Detect - Piping Electronic Pressurized Line Leak Detection 1/7/2025 1/7/2026
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD 1/7/2025 1/7/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 1/7/2025 1/7/2026
Overfill Prev Device Overfill Drop Tube Valve 1/12/2024 1/12/2027
Piping Flexible Double Wall A.P.T. Poly Tech S175SC N/A N/A
Piping Single Wall STP/Tanktop Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026
Spill Contain Device Single Wall Spill Bucket 2/7/2024 2/7/2027
Tank Fiberglass Double Wall Containment Solutions N/A N/A

Additional Tests

Equipment Type Equipment Test Type Test Result Test Date



Tank Number 4

Capacity: 8000 Petroleum Use:
Product: Gasoline - Premium CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 1/10/2018 Abandoned Material:
Current Age: 7 Abandoned Date:
Install Date: 10/16/2017 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/14/2017

Equipment

Equipment Type Equipment Last Passing Date Test Expire Date
Corrosion Prot - Piping Flexible Non-Corrosive N/A N/A
Corrosion Prot - Tank Fiberglass Non-Corrosive N/A N/A
Leak Detect - Piping Electronic Pressurized Line Leak Detection 1/7/2025 1/7/2026
Leak Detect - Piping Siphon Bar N/A N/A
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD 1/7/2025 1/7/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 1/7/2025 1/7/2026
Overfill Prev Device Overfill Drop Tube Valve 1/12/2024 1/12/2027
Piping Flexible Double Wall A.P.T. Poly Tech S175SC N/A N/A
Piping Single Wall STP/Tanktop Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026
Spill Contain Device Single Wall Spill Bucket 2/7/2024 2/7/2027
Tank Fiberglass Double Wall Containment Solutions N/A N/A

Additional Tests

Equipment Type Equipment Test Type Test Result Test Date
Leak Detect - Piping Siphon Bar Functional Pass 1/7/2022



Tank Number 5

Capacity: 8000 Petroleum Use:
Product: E85 CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 1/10/2018 Abandoned Material:
Current Age: 7 Abandoned Date:
Install Date: 10/16/2017 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/14/2017

Equipment

Equipment Type Equipment Last Passing Date Test Expire Date
Corrosion Prot - Piping Flexible Non-Corrosive N/A N/A
Corrosion Prot - Tank Fiberglass Non-Corrosive N/A N/A
Leak Detect - Piping Electronic Pressurized Line Leak Detection 1/7/2025 1/7/2026
Leak Detect - Piping Siphon Bar N/A N/A
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD 1/7/2025 1/7/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 1/7/2025 1/7/2026
Overfill Prev Device Overfill Drop Tube Valve 1/12/2024 1/12/2027
Piping Flexible Double Wall A.P.T. Poly Tech S175SC N/A N/A
Piping Single Wall STP/Tanktop Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026
Spill Contain Device Single Wall Spill Bucket 2/7/2024 2/7/2027
Tank Fiberglass Double Wall Containment Solutions N/A N/A

Additional Tests

Equipment Type Equipment Test Type Test Result Test Date
Leak Detect - Piping Siphon Bar Functional Pass 1/7/2022

Dispenser Information



Name\ID 1/2

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026



Name\ID 11/12

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026



Name\ID 3/4

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026



Name\ID 5/6

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026



Name\ID 7/8

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026



Name\ID 9/10

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 2/7/2024 2/7/2027
Leak Detect - Piping Sump Sensor with positive shutdown 1/7/2025 1/7/2026

MFD Motorfuel Dispensing Forms

Facility Number Name City Received Date Letter
4046489 Casey's General Store # 3646 Forsyth 10/18/2017 Letter Form
Office of the Illinois State Fire Marshal
1035 Stevenson Dr. Springfield, IL 62704 | (217) 785-0969 | Contact Us