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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: 4047226
Status: Active
Facility Name: Sam's Fuel Station 6334
Address: 4334 Prospect Drive
Decatur, IL 62526
County: Macon
Property Parcel: 07-07-26-151-002
Facility Type: Attended Self-Service Station
Owner Type: Private
Green Tag Decal: Y002335
Green Tag Issue Date: 9/13/2023
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: 1/28/1992
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 9/13/2023 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 1/28/1992

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: 9/28/2021 Abandoned Material:
Current Age: 2 Abandoned Date:
Install Date: 7/21/2021 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 9/28/2021

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 8/24/2023 8/24/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 8/24/2023 8/24/2024
Overfill Prev Device Overfill Drop Tube Valve 9/30/2021 9/30/2024
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024
Spill Contain Device Double Wall Spill Bucket 8/24/2023 8/24/2026
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 Flexworks Precision Test Pass 8/24/2023
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 9/30/2021



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: 9/28/2021 Abandoned Material:
Current Age: 2 Abandoned Date:
Install Date: 7/21/2021 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 9/28/2021

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 8/24/2023 8/24/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 8/24/2023 8/24/2024
Overfill Prev Device Overfill Drop Tube Valve 9/30/2021 9/30/2024
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024
Spill Contain Device Double Wall Spill Bucket 8/24/2023 8/24/2026
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 Flexworks Precision Test Pass 8/24/2023
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 9/30/2021



Tank Number 3

Capacity: 12000 Petroleum Use:
Product: Gasoline - Premium CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 9/28/2021 Abandoned Material:
Current Age: 2 Abandoned Date:
Install Date: 7/21/2021 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 9/28/2021

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 8/24/2023 8/24/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 8/24/2023 8/24/2024
Overfill Prev Device Overfill Drop Tube Valve 9/30/2021 9/30/2024
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024
Spill Contain Device Double Wall Spill Bucket 8/24/2023 8/24/2026
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 Flexworks Precision Test Pass 8/24/2023
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 9/30/2021



Tank Number 4

Capacity: 8000 Petroleum Use: None
Product: Diesel Fuel CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 9/28/2021 Abandoned Material:
Current Age: 2 Abandoned Date:
Install Date: 7/21/2021 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 9/28/2021

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 8/24/2023 8/24/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 8/24/2023 8/24/2024
Overfill Prev Device Overfill Drop Tube Valve 9/30/2021 9/30/2024
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024
Spill Contain Device Double Wall Spill Bucket 8/24/2023 8/24/2026
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 Flexworks Precision Test Pass 8/24/2023
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 9/30/2021

Dispenser Information



Name\ID 1/2

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024



Name\ID 11/12

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024



Name\ID 13/14

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024



Name\ID 15/16

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024



Name\ID 3/4

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024



Name\ID 5/6

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024



Name\ID 7/8

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024



Name\ID 9/10

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 8/26/2021 8/26/2024
Leak Detect - Piping Sump Sensor with positive shutdown 8/24/2023 8/24/2024

MFD Motorfuel Dispensing Forms

Facility Number Name City Received Date Letter
4047226 Sam's Fuel Station 6334 Decatur 04/21/2021 Letter Form
Office of the Illinois State Fire Marshal
1035 Stevenson Dr. Springfield, IL 62704 | (217) 785-0969 | Contact Us