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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

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Facility Details

Facility Number:	2026027
Status:	Active
Facility Name:	1422 Countryside Station, LLC - Shell
Address:	1422 W. 55th Street Countryside, IL 60525
County:	Cook
Property Parcel:	18-08-406-001-0000
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Y002602
Green Tag Issue Date:	5/26/2023
Green Tag Expiration Date:	12/31/2025

Owner Details

Owner Name:	Azeem Ali Khan and Nadir Ali Khan
Owner Address:	1422 W. 55th Street Countryside, IL 60525
Owner Status:	Current Owner
Purchase Date:	1/25/2021
Type of Financial Responsibility:	Commercial Insurance
Financial Responsibility Reporting Due Date:	4/26/2025

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	4/27/2023	12/31/2025

Owner Summary

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Owner Number	Owner Name	Owner Status	Purchase Date
U0040103	Azeem Ali Khan and Nadir Ali Khan	Current Owner	1/25/2021
U0038548	1422 Countryside Station, LLC	Former Owner	6/1/2016
U0027695	Farokitian, Mathew	Former Owner	8/10/1998
U0005185	First Il Bank & Tr	Former Owner	4/21/1997

Permits (Unexpired)

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No Active Permits Found

Deficiencies (Current)

No Deficiencies Found

IEMA Numbers Associated with the Facility

IEMA Number	Inspection Date	Inspection Type	Permit Number
N/A	4/13/2023	Abandonment Log	00335-2023ABN

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
20230171	Eligible	1/10/2024	1/18/2024	$5,000	Letter

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Tank Information

Tank Number	Capacity	Product	Status	Regulated Status	Red Tag Issued	Fee Due	Abandon/Removal Date
1	12000	Gasoline - Regular	Abandoned in place	Federal		$0.00	04/13/2023 - ABN
2	10000	Gasoline - Premium	Currently in use	Federal		$0.00
3	10000	Gasoline - Regular	Currently in use	Federal		$0.00

Dispenser Information

Name\ID	Status
1/2	Active
3/4	Active
5/6	Active
7/8	Active
9/10	Active

MFD Motorfuel Dispensing Forms

No Forms Found