Information
JB Pritzker, Governor

Michele L Pankow, State Fire Marshal

Division of Petroleum & Chemical Safety
State of Illinois
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Division of Petroleum & Chemical Safety

 

Facility Details

Facility Number: 1042691
Status: Active
Facility Name: Sam's Club #8297
Address: 7151 Walton Street Rockford, IL 61108
County: Winnebago
Property Parcel:
Facility Type: Attended Self-Service Station
Owner Type: Private
Green Tag Decal: Y001140
Green Tag Issue Date: 7/19/2023
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: 5/26/2005
Type of Financial Responsibility: Commercial Insurance
Financial Responsibility Reporting Due Date: 4/29/2026

Motor Fuel Dispensing Permits

MFD Permit Type Issue Date Expiration Date
Self Service 7/19/2023 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 5/26/2005

Permits (Unexpired)

Click for permit history

No Active Permits Found

Notice of Violatlions (Current)

No Notice of Violations 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: 5/18/2005 Abandoned Material:
Current Age: 20 Abandoned Date:
Install Date: 3/10/2005 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 4/25/2005

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 5/13/2025 5/13/2026
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus 5/13/2025 5/13/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 6/25/2025 6/25/2026
Overfill Prev Device Overfill Drop Tube Valve 6/11/2024 6/11/2027
Piping Polyethylene Chase N/A N/A
Piping Flexible Single Wall Piping in Chase N/A N/A
Piping Single Wall STP/Tanktop Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026
Leak Detect - Piping Piping Sump Sensors Not Regulated N/A N/A
Spill Contain Device Double Wall Spill Bucket 5/13/2025 5/13/2028
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 (Piping) Pass 7/30/2020
Piping Flexible Single Wall Piping in Chase Precision Test (Piping) Pass 5/13/2025
Piping Polyethylene Chase Precision Test (Piping) Pass 5/13/2025
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 6/11/2024



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: 5/18/2005 Abandoned Material:
Current Age: 20 Abandoned Date:
Install Date: 3/10/2005 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 4/25/2005

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 5/13/2025 5/13/2026
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus 5/13/2025 5/13/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 6/25/2025 6/25/2026
Overfill Prev Device Overfill Drop Tube Valve 6/11/2024 6/11/2027
Piping Polyethylene Chase N/A N/A
Piping Flexible Single Wall Piping in Chase N/A N/A
Piping Single Wall STP/Tanktop Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026
Leak Detect - Piping Piping Sump Sensors Not Regulated N/A N/A
Spill Contain Device Double Wall Spill Bucket 5/13/2025 5/13/2028
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 (Piping) Pass 7/30/2020
Piping Flexible Single Wall Piping in Chase Precision Test (Piping) Pass 5/13/2025
Piping Polyethylene Chase Precision Test (Piping) Pass 5/13/2025
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 6/11/2024



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: 5/18/2005 Abandoned Material:
Current Age: 20 Abandoned Date:
Install Date: 3/10/2005 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 4/25/2005

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 5/13/2025 5/13/2026
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 450 Plus 5/13/2025 5/13/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 5/13/2025 5/13/2026
Overfill Prev Device Overfill Drop Tube Valve 6/11/2024 6/11/2027
Piping Polyethylene Chase N/A N/A
Piping Flexible Single Wall Piping in Chase N/A N/A
Piping Single Wall STP/Tanktop Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026
Leak Detect - Piping Piping Sump Sensors Not Regulated N/A N/A
Spill Contain Device Single Wall Spill Bucket 5/13/2025 5/13/2028
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 (Piping) Pass 7/30/2020
Piping Flexible Single Wall Piping in Chase Precision Test (Piping) Pass 5/13/2025
Piping Polyethylene Chase Precision Test (Piping) Pass 5/13/2025
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 6/11/2024

Dispenser Information



Name\ID 1/2

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026



Name\ID 11/12

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026



Name\ID 3/4

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026



Name\ID 5/6

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026



Name\ID 7/8

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026



Name\ID 9/10

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 5/13/2024 5/13/2027
Leak Detect - Piping Sump Sensor with positive shutdown 5/13/2025 5/13/2026

MFD Motorfuel Dispensing Forms

No Forms Found

Office of the Illinois State Fire Marshal
1035 Stevenson Dr. Springfield, IL 62704 | (217) 785-0969 | Contact Us