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:	1038611
Status:	Active
Facility Name:	Samra 1403, Inc. d/b/a Pate Gas Mart, Inc.
Address:	1403 Pate Plaza Road South Beloit, IL 61080
County:	Winnebago
Property Parcel:	04-04-100-002
Facility Type:	Attended Self-Service/Unattended Self-Service
Owner Type:	Private
Green Tag Decal:	Z000828
Green Tag Issue Date:	1/4/2024
Green Tag Expiration Date:	12/31/2026

Owner Details

Owner Name:	Samra 1403, Inc.
Owner Address:	1403 Pate Plaza Dr. South Beloit, IL 61080
Owner Status:	Current Owner
Purchase Date:	11/25/2019
Type of Financial Responsibility:	Designated Savings Account
Financial Responsibility Reporting Due Date:	1/18/2025

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	1/4/2024	12/31/2026
Unattended Self Service	1/4/2024	12/31/2026

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0039865	Samra 1403, Inc.	Current Owner	11/25/2019
U0032330	Popingo, LLC	Former Owner	7/12/2010
U0035872	Prayog, LLC	Former Owner
U0028433	Quick-N-Save	Former Owner

Permits (Unexpired)

Click for permit history

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:	12000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	7/13/1999		Abandoned Material:
Current Age:	24		Abandoned Date:
Install Date:	6/11/1999		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	6/11/1999

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	7/26/2023	7/26/2026
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Composite Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	7/26/2023	7/26/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	7/26/2023	7/26/2024
Overfill Prev Device	Overfill Drop Tube Valve	7/26/2023	7/26/2026
Piping	Flexible Double Wall A.P.T. Poly Tech	N/A	N/A
Piping	Single Wall STP/Tanktop Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	7/26/2023	7/26/2026
Tank	Composite Single Wall ACT 100	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech	Precision Test	Pass	6/19/2020

Tank Number 2

Capacity:	8000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	7/13/1999		Abandoned Material:
Current Age:	24		Abandoned Date:
Install Date:	6/11/1999		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	6/11/1999

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	7/26/2023	7/26/2026
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Composite Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	7/26/2023	7/26/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	7/26/2023	7/26/2024
Overfill Prev Device	Overfill Drop Tube Valve	7/26/2023	7/26/2026
Piping	Flexible Double Wall A.P.T. Poly Tech	N/A	N/A
Piping	Single Wall STP/Tanktop Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	7/26/2023	7/26/2026
Tank	Composite Single Wall ACT 100	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech	Precision Test	Pass	6/19/2020

Tank Number 3

Capacity:	4000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	7/13/1999		Abandoned Material:
Current Age:	24		Abandoned Date:
Install Date:	6/11/1999		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	6/11/1999

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector	7/26/2023	7/26/2026
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Composite Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	7/26/2023	7/26/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350 Plus with CSLD	7/26/2023	7/26/2024
Overfill Prev Device	Overfill Drop Tube Valve	7/26/2023	7/26/2026
Piping	Flexible Double Wall A.P.T. Poly Tech	N/A	N/A
Piping	Single Wall STP/Tanktop Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	7/26/2023	7/26/2026
Tank	Composite Single Wall ACT 100	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech	Precision Test	Pass	6/19/2020

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A

MFD Motorfuel Dispensing Forms

No Forms Found