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:	4041694
Status:	Active
Facility Name:	Sam's Club #4815
Address:	2151 Shepherd Road Normal, IL 61761
County:	McLean
Property Parcel:	14-23-402-004
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	X002744
Green Tag Issue Date:	10/18/2022
Green Tag Expiration Date:	12/31/2024

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	10/20/2022	12/31/2024

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0029973	Sam's West, Inc.	Current Owner
U0031303	Wal-Mart Stores, Inc.	Former Owner

Permits (Unexpired)

Click for permit history

Permit Number	Type	Status	OSFM Receive Date	Issue Date	Expiration Date	Documents
00102-2024UPG	Upgrade	Approved / Issued	1/26/2024	1/27/2024	7/29/2024	Documents

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:	9/10/2003		Abandoned Material:
Current Age:	20		Abandoned Date:
Install Date:	7/14/2003		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	7/1/2003

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	10/17/2023	10/17/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD	10/17/2023	10/17/2024
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	10/17/2023	10/17/2024
Overfill Prev Device	Overfill Drop Tube Valve	10/17/2023	10/17/2026
Piping	Fiberglass Double Wall A.O. Smith	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/15/2021	9/15/2024
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024
Spill Contain Device	Single Wall Spill Bucket	10/17/2023	10/17/2026
Tank	Fiberglass Double Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Double Wall A.O. Smith	Precision Test	Pass	10/17/2023
Tank	Fiberglass Double Wall	Precision Test (Tank)	Pass	11/9/2022

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:	9/10/2003		Abandoned Material:
Current Age:	20		Abandoned Date:
Install Date:	7/14/2003		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	7/1/2003

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	10/17/2023	10/17/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD	10/17/2023	10/17/2024
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	10/17/2023	10/17/2024
Overfill Prev Device	Overfill Drop Tube Valve	10/17/2023	10/17/2026
Piping	Fiberglass Double Wall A.O. Smith	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/15/2021	9/15/2024
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024
Spill Contain Device	Double Wall Spill Bucket	2/27/2024	2/27/2027
Tank	Fiberglass Double Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Double Wall A.O. Smith	Precision Test	Pass	10/17/2023
Tank	Fiberglass Double Wall	Precision Test (Tank)	Pass	11/9/2022

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:	9/10/2003		Abandoned Material:
Current Age:	20		Abandoned Date:
Install Date:	7/14/2003		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	7/1/2003

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Fiberglass Non-Corrosive	N/A	N/A
Leak Detect - Piping	Mechanical Pressurized Line Leak Detection	10/17/2023	10/17/2024
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD	10/17/2023	10/17/2024
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	2/27/2024	2/27/2025
Overfill Prev Device	Overfill Drop Tube Valve	2/27/2024	2/27/2027
Piping	Fiberglass Double Wall A.O. Smith	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/15/2021	9/15/2024
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024
Spill Contain Device	Single Wall Spill Bucket	10/17/2023	10/17/2026
Tank	Fiberglass Double Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Fiberglass Double Wall A.O. Smith	Precision Test	Pass	10/17/2023
Tank	Fiberglass Double Wall	Precision Test (Tank)	Pass	11/9/2022

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024

Name\ID 11/12

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024

Name\ID 7/8

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024

Name\ID 9/10

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated Not Installed	N/A	N/A
Leak Detect - Piping	Sump Sensor	10/17/2023	10/17/2024

MFD Motorfuel Dispensing Forms

No Forms Found