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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

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Facility Details

Facility Number:	7002499
Status:	Closed
Facility Name:	Good Samaritan Regional Health Center
Address:	605 N. 12th Street Mount Vernon, IL 62864
County:	Jefferson
Property Parcel:
Facility Type:	None
Owner Type:
Green Tag Decal:
Green Tag Issue Date:
Green Tag Expiration Date:

Owner Details

Owner Name:	Good Samaritan Regional Health Center
Owner Address:	1 Good Samaritan Way Mount Vernon, IL 62864
Owner Status:	Current Owner
Purchase Date:	2/29/1996
Type of Financial Responsibility:
Financial Responsibility Reporting Due Date:

Motor Fuel Dispensing Permits

No MFD Permits Found

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0005979	Good Samaritan Regional Health Center	Current Owner	2/29/1996

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
14-0343	4/10/2014	Removal Log	00258-2014REM
14-0343	4/8/2014	Removal Log	00258-2014REM
14-0343	4/9/2014	Removal Log	00258-2014REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number	Status	OSFM Received Date	OSFM Response Date	Deductible	Letter
14-0343	Partial Eligible	7/23/2014	7/23/2014	$5,000

Pay Tank Fees Online

Tank Information

Tank Number	Capacity	Product	Status	Regulated Status	Red Tag Issued	Fee Due	Abandon/Removal Date
1	2000	Diesel Fuel	Removed	Federal		$0.00	04/08/2014 - REM
2	5000	Diesel Fuel	Removed	Federal		$0.00	04/08/2014 - REM
3	5000	Diesel Fuel	Removed	State		$0.00	04/08/2014 - REM
4	15000	Heating Oil	Removed	State			04/09/2014 - REM
5	12000	Heating Oil	Removed	State			04/10/2014 - REM

Dispenser Information

Name\ID	Status

MFD Motorfuel Dispensing Forms

No Forms Found