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:	2029716
Status:	Closed
Facility Name:	Box Form, Inc.
Address:	5440 N Northwest Hwy Chicago, IL 60630
County:	Cook
Property Parcel:
Facility Type:	Industrial / Manufacturing
Owner Type:	Private
Green Tag Decal:
Green Tag Issue Date:
Green Tag Expiration Date:

Owner Details

Owner Name:	Topweb, LLC
Owner Address:	1645 W. Fullerton Avenue Chicago, IL 60614
Owner Status:	Current Owner
Purchase Date:
Type of Financial Responsibility:	Self-Insurance
Financial Responsibility Reporting Due Date:	11/1/2012

Motor Fuel Dispensing Permits

No MFD Permits Found

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0036293	Topweb, LLC	Current Owner
U0019124	5566 Bldg Ptr C/O Box Form Inc	Former Owner	1/19/1983

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
11-1136	11/2/2011	Removal Log	110571
11-1172	11/2/2011	Removal Log	110571
92-1075	4/30/1996	Removal Log
92-1075	9/19/2006	Removal Log	108948

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
92-1075	Eligible	2/15/1994	2/24/1994	$15,000
11-1136	Eligible	8/3/2012	9/28/2012	$5,000
11-1172	Eligible	8/3/2012	9/28/2012	$5,000

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	1000		Petroleum Use:
Product:	Heating Oil		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	9/19/2006
OSFM First Notify Date:	4/7/1992		Abandoned Material:
Current Age:	51		Abandoned Date:
Install Date:	1/1/1955		Red Tag Issue Date:
Last Used Date:	1/1/1976		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 2

Capacity:	3000		Petroleum Use:	Consumptive Use on Premises for Heating
Product:	Heating Oil		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	State		Removed Date:	4/30/1996
OSFM First Notify Date:	4/7/1992		Abandoned Material:
Current Age:	43		Abandoned Date:
Install Date:			Red Tag Issue Date:
Last Used Date:	1/1/1976		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 3

Capacity:	2000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	4/30/1996
OSFM First Notify Date:	4/7/1992		Abandoned Material:
Current Age:	25		Abandoned Date:
Install Date:			Red Tag Issue Date:
Last Used Date:	1/1/1980		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 4

Capacity:	3000		Petroleum Use:	Consumptive Use on Premises for Heating
Product:	Heating Oil		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	State		Removed Date:	11/2/2011
OSFM First Notify Date:	4/7/1992		Abandoned Material:	Inert material mixed with portland cement
Current Age:	22		Abandoned Date:	5/14/1996
Install Date:			Red Tag Issue Date:
Last Used Date:	1/1/1980		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 5

Capacity:	1000		Petroleum Use:	Consumptive Use on Premises for Heating
Product:	Heating Oil		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	State		Removed Date:	11/2/2011
OSFM First Notify Date:	7/23/1992		Abandoned Material:	Inert material mixed with portland cement
Current Age:	41		Abandoned Date:	5/14/1996
Install Date:			Red Tag Issue Date:
Last Used Date:	2/1/1983		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 6

Capacity:	3000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	11/2/2011
OSFM First Notify Date:	11/1/2011		Abandoned Material:
Current Age:			Abandoned Date:
Install Date:			Red Tag Issue Date:
Last Used Date:	1/1/1980		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 7

Capacity:	3000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Does Not Exist		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	11/1/2011		Abandoned Material:
Current Age:			Abandoned Date:
Install Date:			Red Tag Issue Date:
Last Used Date:	1/1/1980		Fee Due:	$0.00
Product Date:

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Dispenser Information

MFD Motorfuel Dispensing Forms

No Forms Found