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:	2041404
Status:	Closed
Facility Name:	Sam's Club #8143
Address:	808 S. State Route 59 Naperville, IL 60540
County:	Du Page
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	R001021
Green Tag Issue Date:	5/5/2016
Green Tag Expiration Date:	12/31/2018

Owner Details

Owner Name:	Sam's West, Inc.
Owner Address:	2101 SE Simple Savings Drive Bentonville, AR 727160745
Owner Status:	Current Owner
Purchase Date:	11/22/2002
Type of Financial Responsibility:	Commercial Insurance
Financial Responsibility Reporting Due Date:	5/3/2019

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	5/5/2016	12/31/2018

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0029973	Sam's West, Inc.	Current Owner	11/22/2002

Permits (Unexpired)

Click for permit history

No Active Permits Found

Notice of Violations (Current)

No Notice of Violations Found

IEMA Numbers Associated with the Facility

IEMA Number	Inspection Date	Inspection Type	Permit Number
18-0654	7/10/2018	Removal Log	00520-2018REM
18-0654	7/11/2018	Removal Log	00520-2018REM

LUST Fund Eligibility and Deductibility Determinations

No Applications Found

Pay Tank Fees Online

Tank Information

Tank Number 1

Capacity:	20000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	7/10/2018
OSFM First Notify Date:	1/30/2003		Abandoned Material:
Current Age:	15		Abandoned Date:
Install Date:	11/22/2002		Red Tag Issue Date:
Last Used Date:	1/26/2018		Fee Due:	$0.00
Product Date:	11/22/2002

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	6/3/2015	6/3/2016
Leak Detect - Piping	Sump Sensor	6/3/2015	6/3/2016
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	6/3/2015	6/3/2016
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Flexible Double Wall OPW Pisces	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket
Tank	Fiberglass Double Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 2

Capacity:	20000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	7/10/2018
OSFM First Notify Date:	1/30/2003		Abandoned Material:
Current Age:	15		Abandoned Date:
Install Date:	11/22/2002		Red Tag Issue Date:
Last Used Date:	1/26/2018		Fee Due:	$0.00
Product Date:	11/22/2002

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	6/3/2015	6/3/2016
Leak Detect - Piping	Sump Sensor	6/3/2015	6/3/2016
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	6/3/2015	6/3/2016
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Flexible Double Wall OPW Pisces	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket
Tank	Fiberglass Double Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 3

Capacity:	20000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	7/11/2018
OSFM First Notify Date:	1/30/2003		Abandoned Material:
Current Age:	15		Abandoned Date:
Install Date:	11/22/2002		Red Tag Issue Date:
Last Used Date:	1/26/2018		Fee Due:	$0.00
Product Date:	11/22/2002

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	6/3/2015	6/3/2016
Leak Detect - Piping	Sump Sensor	6/3/2015	6/3/2016
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 450 Plus with CSLD
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	6/3/2015	6/3/2016
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Flexible Double Wall OPW Pisces	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket
Tank	Fiberglass Double Wall	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Dispenser Information

MFD Motorfuel Dispensing Forms

No Forms Found