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:	2009880
Status:	Active
Facility Name:	Fox Lake Mobil
Address:	95 E. Grand Ave. Fox Lake, IL 60020
County:	Lake
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Y001228
Green Tag Issue Date:	3/30/2023
Green Tag Expiration Date:	12/31/2025

Owner Details

Owner Name:	Karim Ebrahim
Owner Address:	95 E. Grand Ave. Fox Lake, IL 60020
Owner Status:	Current Owner
Purchase Date:	7/26/2015
Type of Financial Responsibility:	Designated Savings Account
Financial Responsibility Reporting Due Date:	4/1/2024

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	1/5/2023	12/31/2025

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0038673	Ebrahim, Karim	Current Owner	7/26/2015
U0031502	Grand Avenue Mini Mart & Gas, Inc.	Former Owner	9/3/2003
U0003073	Clark Retail Enterprises, Inc.	Former Owner	11/22/1988
U0029789	Clark Retail Enterprises, Inc.	Former Owner
U0028787	Clark Retail Enterprises, Inc.,	Former Owner

Permits (Unexpired)

Click for permit history

No Active Permits Found

Deficiencies (Current)

No Deficiencies Found

IEMA Numbers Associated with the Facility

IEMA Number	Inspection Date	Inspection Type	Permit Number
06-1286	5/17/2007	Removal Log	00569-2007REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
95-1100	Eligible	8/29/1995	10/13/1995	$10,000
95-1100	Eligible	5/6/2004	5/19/2004	$10,000
95-1100	Returned	9/8/2004	9/21/2004	$Not Selected
95-1100	Eligible	10/4/2004	10/13/2004	$10,000
06-1286	Eligible	10/23/2006	11/1/2006	$10,000

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	4000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	5/17/2007
OSFM First Notify Date:	11/23/1987		Abandoned Material:
Current Age:	41		Abandoned Date:
Install Date:	1/1/1966		Red Tag Issue Date:
Last Used Date:	3/11/2007		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector Flex connector spike anode
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal
Leak Detect - Tank	Automatic Tank Gauging
Piping	Double Wall steel	N/A	N/A
Piping	Fiberglass Double Wall	N/A	N/A
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 2

Capacity:	4000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	5/17/2007
OSFM First Notify Date:	11/23/1987		Abandoned Material:
Current Age:	41		Abandoned Date:
Install Date:	1/1/1966		Red Tag Issue Date:
Last Used Date:	3/11/2007		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Flex Connector Flex connector spike anode
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal
Leak Detect - Tank	Automatic Tank Gauging
Piping	Double Wall steel	N/A	N/A
Piping	Fiberglass Double Wall	N/A	N/A
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 3

Capacity:	4000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	5/17/2007
OSFM First Notify Date:	11/23/1987		Abandoned Material:
Current Age:	41		Abandoned Date:
Install Date:	1/1/1966		Red Tag Issue Date:
Last Used Date:	3/11/2007		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal
Leak Detect - Piping	Pressurized Line Leak Detection
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection
Leak Detect - Tank	Automatic Tank Gauging
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Fiberglass Double Wall	N/A	N/A
Spill Contain Device	Manhole Field Constructed
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 4

Capacity:	4000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	5/17/2007
OSFM First Notify Date:	11/23/1987		Abandoned Material:
Current Age:	41		Abandoned Date:
Install Date:	1/1/1966		Red Tag Issue Date:
Last Used Date:	3/11/2007		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal
Leak Detect - Piping	Pressurized Line Leak Detection
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection
Leak Detect - Tank	Automatic Tank Gauging
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Fiberglass Double Wall	N/A	N/A
Spill Contain Device	Manhole Field Constructed
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 5

Capacity:	12000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	10/22/2007		Abandoned Material:
Current Age:	16		Abandoned Date:
Install Date:	6/1/2007		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:

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	2/19/2024	2/19/2025
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350	2/19/2024	2/19/2025
Leak Detect - Tank	Hydrostatic Reservoir Interstitial Monitoring Sensors	2/19/2024	2/19/2025
Overfill Prev Device	Overfill Drop Tube Valve	2/1/2023	2/1/2026
Piping	Flexible Double Wall A.P.T. Poly Tech P175SC	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	2/1/2023	2/1/2026
Leak Detect - Piping	Sump Sensor	2/19/2024	2/19/2025
Spill Contain Device	Single Wall Spill Bucket	2/1/2023	2/1/2026
Tank	Fiberglass Brine Filled Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech P175SC	Precision Test	Pass	2/19/2024
Tank	Fiberglass Brine Filled Double Wall XERXES	Precision Test (Tank)	Pass	2/1/2023

Tank Number 6

Capacity:	4000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	10/22/2007		Abandoned Material:
Current Age:	16		Abandoned Date:
Install Date:	6/1/2007		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:

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	2/19/2024	2/19/2025
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350	2/19/2024	2/19/2025
Leak Detect - Tank	Hydrostatic Reservoir Interstitial Monitoring Sensors	2/19/2024	2/19/2025
Overfill Prev Device	Overfill Drop Tube Valve	2/1/2023	2/1/2026
Piping	Flexible Double Wall A.P.T. Poly Tech P175SC	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	2/1/2023	2/1/2026
Leak Detect - Piping	Sump Sensor	2/19/2024	2/19/2025
Spill Contain Device	Single Wall Spill Bucket	2/1/2023	2/1/2026
Tank	Fiberglass Brine Filled Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall A.P.T. Poly Tech P175SC	Precision Test	Pass	2/19/2024
Tank	Fiberglass Brine Filled Double Wall XERXES	Precision Test (Tank)	Pass	2/1/2023

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	2/1/2023	2/1/2026
Leak Detect - Piping	Sump Sensor	2/19/2024	2/19/2025

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	2/1/2023	2/1/2026
Leak Detect - Piping	Sump Sensor	2/19/2024	2/19/2025

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	2/1/2023	2/1/2026
Leak Detect - Piping	Sump Sensor	2/19/2024	2/19/2025

MFD Motorfuel Dispensing Forms

No Forms Found