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:	1042691
Status:	Active
Facility Name:	Sam's Club #8297
Address:	7151 Walton Street Rockford, IL 61108
County:	Winnebago
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Y001140
Green Tag Issue Date:	7/19/2023
Green Tag Expiration Date:	12/31/2025

Owner Details

Owner Name:	Sam's West, Inc.
Owner Address:	2101 SE Simple Savings Drive Bentonville, AR 727160745
Owner Status:	Current Owner
Purchase Date:	5/26/2005
Type of Financial Responsibility:	Commercial Insurance
Financial Responsibility Reporting Due Date:	4/29/2025

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	7/19/2023	12/31/2025

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0029973	Sam's West, Inc.	Current Owner	5/26/2005

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:	20000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/18/2005		Abandoned Material:
Current Age:	19		Abandoned Date:
Install Date:	3/10/2005		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	4/25/2005

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	Mechanical Pressurized Line Leak Detection	6/20/2023	6/20/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus	6/20/2023	6/20/2024
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	6/20/2023	6/20/2024
Overfill Prev Device	Overfill Drop Tube Valve	7/20/2021	7/20/2024
Piping	Polyethylene Chase	N/A	N/A
Piping	Flexible Single Wall Piping in Chase	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024
Leak Detect - Piping	Piping Sump Sensors Not Regulated	N/A	N/A
Spill Contain Device	Double Wall Spill Bucket	6/20/2023	6/20/2026
Tank	Fiberglass Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall OPW Pisces	Precision Test	Pass	7/30/2020
Piping	Flexible Single Wall Piping in Chase	Precision Test	Pass	6/20/2023
Piping	Polyethylene Chase	Precision Test	Pass	6/20/2023
Tank	Fiberglass Double Wall XERXES	Precision Test (Tank)	Pass	8/8/2019

Tank Number 2

Capacity:	20000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/18/2005		Abandoned Material:
Current Age:	19		Abandoned Date:
Install Date:	3/10/2005		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	4/25/2005

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	Mechanical Pressurized Line Leak Detection	6/20/2023	6/20/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus	6/20/2023	6/20/2024
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	6/20/2023	6/20/2024
Overfill Prev Device	Overfill Drop Tube Valve	7/20/2021	7/20/2024
Piping	Polyethylene Chase	N/A	N/A
Piping	Flexible Single Wall Piping in Chase	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024
Leak Detect - Piping	Piping Sump Sensors Not Regulated	N/A	N/A
Spill Contain Device	Double Wall Spill Bucket	6/20/2023	6/20/2026
Tank	Fiberglass Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall OPW Pisces	Precision Test	Pass	7/30/2020
Piping	Flexible Single Wall Piping in Chase	Precision Test	Pass	6/20/2023
Piping	Polyethylene Chase	Precision Test	Pass	6/20/2023
Tank	Fiberglass Double Wall XERXES	Precision Test (Tank)	Pass	8/8/2019

Tank Number 3

Capacity:	20000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/18/2005		Abandoned Material:
Current Age:	19		Abandoned Date:
Install Date:	3/10/2005		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	4/25/2005

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	Mechanical Pressurized Line Leak Detection	6/20/2023	6/20/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus	6/20/2023	6/20/2024
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	6/20/2023	6/20/2024
Overfill Prev Device	Overfill Drop Tube Valve	9/27/2021	9/27/2024
Piping	Polyethylene Chase	N/A	N/A
Piping	Flexible Single Wall Piping in Chase	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024
Leak Detect - Piping	Piping Sump Sensors Not Regulated	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	6/20/2023	6/20/2026
Tank	Fiberglass Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall OPW Pisces	Precision Test	Pass	7/30/2020
Piping	Flexible Single Wall Piping in Chase	Precision Test	Pass	6/20/2023
Piping	Polyethylene Chase	Precision Test	Pass	6/20/2023
Tank	Fiberglass Double Wall XERXES	Precision Test (Tank)	Pass	8/8/2019

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024

Name\ID 11/12

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024

Name\ID 7/8

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024

Name\ID 9/10

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	6/14/2021	6/14/2024
Leak Detect - Piping	Sump Sensor with positive shutdown	6/20/2023	6/20/2024

MFD Motorfuel Dispensing Forms

No Forms Found