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: 2040790
Status: Active
Facility Name: Sam's Club #6464
Address: 101 West Oakton St.
Des Plaines, IL 60018
County: Cook
Property Parcel: 08-25-204-003-0000
Facility Type: Attended Self-Service Station
Owner Type: Private
Green Tag Decal: Y001452
Green Tag Issue Date: 1/17/2023
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:
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 1/17/2023 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
U0017352 Wal-Mart Stores, Inc. Former Owner 4/12/2002

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: 5/28/2002 Abandoned Material:
Current Age: 22 Abandoned Date:
Install Date: 4/18/2002 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 Mechanical Pressurized Line Leak Detection 5/23/2023 5/23/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 5/23/2023 5/23/2024
Overfill Prev Device Overfill Drop Tube Valve 6/23/2022 6/23/2025
Piping Flexible Double Wall OPW Pisces N/A N/A
Piping Single Wall STP/Tanktop Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024
Spill Contain Device Double Wall Spill Bucket 5/23/2023 5/23/2026
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 5/23/2023
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 8/20/2019



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: 5/28/2002 Abandoned Material:
Current Age: 22 Abandoned Date:
Install Date: 4/18/2002 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 Mechanical Pressurized Line Leak Detection 5/23/2023 5/23/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 5/23/2023 5/23/2024
Overfill Prev Device Overfill Drop Tube Valve 7/15/2022 7/15/2025
Piping Flexible Double Wall OPW Pisces N/A N/A
Piping Single Wall STP/Tanktop Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024
Spill Contain Device Double Wall Spill Bucket 5/23/2023 5/23/2026
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 5/23/2023
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 8/20/2019



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: 5/28/2002 Abandoned Material:
Current Age: 22 Abandoned Date:
Install Date: 4/18/2002 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 Mechanical Pressurized Line Leak Detection 5/23/2023 5/23/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 5/23/2023 5/23/2024
Overfill Prev Device Overfill Drop Tube Valve 7/15/2022 7/15/2025
Piping Flexible Double Wall OPW Pisces N/A N/A
Piping Single Wall STP/Tanktop Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024
Spill Contain Device Double Wall Spill Bucket 5/23/2023 5/23/2026
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 5/23/2023
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 8/20/2019

Dispenser Information



Name\ID 1/2

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024



Name\ID 11/12

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024



Name\ID 3/4

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024



Name\ID 5/6

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024



Name\ID 7/8

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024



Name\ID 9/10

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 1/16/2023 1/16/2026
Leak Detect - Piping Sump Sensor with positive shutdown 5/23/2023 5/23/2024

MFD Motorfuel Dispensing Forms

No Forms Found

Office of the Illinois State Fire Marshal
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