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:	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

Click for Facility/Tank Ownership history

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)

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
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

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	12000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Abandoned in place		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/10/1990		Abandoned Material:	Inert material mixed with portland cement
Current Age:	43		Abandoned Date:	4/13/2023
Install Date:	5/10/1981		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	Sacrificial Anode Cathodic Protection	7/12/2021	7/12/2024
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal	6/16/2020	6/16/2025
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	9/26/2022	9/26/2023
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350j with CSLD	9/26/2022	9/26/2023
Overfill Prev Device	Overfill Drop Tube Valve	7/12/2021	7/12/2024
Piping	Fiberglass Single Wall Piping Ameron	N/A	N/A
Piping	Not Installed STP/Tanktop Sump	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	5/31/2019	5/31/2022
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Double Wall	Precision Test	Pass	5/31/2019
Piping	Fiberglass Single Wall Piping Ameron	Precision Test	Pass	6/17/2020
Tank	Steel Single Wall	Precision Test (Tank)	Fail	1/5/2023

Tank Number 2

Capacity:	10000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/10/1990		Abandoned Material:
Current Age:	43		Abandoned Date:
Install Date:	5/10/1981		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	Sacrificial Anode Cathodic Protection	7/12/2021	7/12/2024
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Lining Materials Internal	6/16/2020	6/16/2025
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	2/13/2024	2/13/2025
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350j with CSLD	2/13/2024	2/13/2025
Overfill Prev Device	Overfill Drop Tube Valve	7/12/2021	7/12/2024
Piping	Fiberglass Single Wall Piping Ameron	N/A	N/A
Piping	Not Installed STP/Tanktop Sump	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	9/26/2022	9/26/2025
Tank	Steel Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Double Wall	Precision Test	Pass	5/31/2019
Piping	Fiberglass Single Wall Piping Ameron	Precision Test	Pass	4/20/2023
Tank	Steel Single Wall	Precision Test (Tank)	Pass	7/12/2021

Tank Number 3

Capacity:	10000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	5/10/1990		Abandoned Material:
Current Age:	35		Abandoned Date:
Install Date:	6/28/1988		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	6/28/1988

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Sacrificial Anode Cathodic Protection	7/12/2021	7/12/2024
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	2/13/2024	2/13/2025
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350j with CSLD	2/13/2024	2/13/2025
Overfill Prev Device	Overfill Drop Tube Valve	7/12/2021	7/12/2024
Piping	Fiberglass Single Wall Piping	N/A	N/A
Piping	Not Installed STP/Tanktop Sump	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	9/26/2022	9/26/2025
Tank	Fiberglass Single Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Double Wall	Precision Test	Pass	5/31/2019
Piping	Fiberglass Single Wall Piping	Precision Test	Pass	4/20/2023
Piping	Fiberglass Single Wall Piping Ameron	Precision Test	Pass	5/8/2020
Tank	Fiberglass Single Wall	Precision Test (Tank)	Pass	4/14/2023

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A

Name\ID 7/8

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A

Name\ID 9/10

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Not Installed UDC Sump	N/A	N/A

MFD Motorfuel Dispensing Forms

No Forms Found