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:	1027495
Status:	Closed
Facility Name:	Van Matre Health South
Address:	950 South Mulford Rockford, IL 61108
County:	Winnebago
Property Parcel:
Facility Type:	Private Institution
Owner Type:	Private
Green Tag Decal:	R006043
Green Tag Issue Date:	8/29/2016
Green Tag Expiration Date:	12/31/2018

Owner Details

Owner Name:	Van Matre Health South
Owner Address:	950 South Mulford Rockford, IL 61108
Owner Status:	Current Owner
Purchase Date:
Type of Financial Responsibility:	Self-Insurance
Financial Responsibility Reporting Due Date:	10/1/2016

Motor Fuel Dispensing Permits

No MFD Permits Found

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0031115	Van Matre Health South	Current Owner
U0018071	Charter Hospital Of Rockford	Former Owner	12/31/1967
U0012994	Rockford Memorial Hospital	Former Owner

Permits (Unexpired)

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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

No Applications Found

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	1000		Petroleum Use:	Back-up Generator
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	11/16/2016
OSFM First Notify Date:	2/28/1991		Abandoned Material:
Current Age:	27		Abandoned Date:
Install Date:	10/1/1989		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	10/1/1989

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Composite Secondary Containment	N/A	N/A
Corrosion Prot - Tank	STIP3 Cathodic Protection with Dielectric Coating	5/7/2014	5/7/2017
Leak Detect - Piping	American with Sensors/No Test Suction	N/A	N/A
Leak Detect - Piping	Sump Sensor	1/21/2016	1/21/2017
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 300 with CSLD
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	1/21/2016	1/21/2017
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Chase Secondary Containment steel primary within composite secondary	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket
Tank	STIP3 Double Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Leak Detect - Piping	American with Annual Prec Line Testing Suction	Precision Test	Pass	2/27/2006

Dispenser Information

MFD Motorfuel Dispensing Forms

No Forms Found