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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:
2014091
Status:
Active
Facility Name:
Sam's Auto Service
Address:
4401 St Charles Road Bellwood, IL 60104
County:
Cook
Property Parcel:
15-08-215-065-0000
Facility Type:
Attended Self-Service Station
Owner Type:
Private
Green Tag Decal:
Z000059
Green Tag Issue Date:
5/29/2024
Green Tag Expiration Date:
12/31/2026
Owner Details
Owner Name:
Bassam Shaheen
Owner Address:
4401 St Charles Road Bellwood, IL 60104
Owner Status:
Current Owner
Purchase Date:
12/31/1984
Type of Financial Responsibility:
Commercial Insurance
Financial Responsibility Reporting Due Date:
6/17/2026
Motor Fuel Dispensing Permits
MFD Permit Type
Issue Date
Expiration Date
Self Service
5/29/2024
12/31/2026
Owner Summary
Click for Facility/Tank Ownership history
Owner Number
Owner Name
Owner Status
Purchase Date
U0013806
Shaheen, Bassam
Current Owner
12/31/1984
U0008295
Kayo Oil Co
Former Owner
12/31/1967
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
IEMA Number
Inspection Date
Inspection Type
Permit Number
94-2131
9/19/1994
Removal Log
LUST
Fund Eligibility and Deductibility Determinations
IEMA Number
Status
OSFM Received Date
OSFM Response Date
Deductible
Letter
94-2131
Eligible
9/27/1994
10/13/1994
$15,000
Pay Tank Fees Online
Tank Information
Tank Number 1
Capacity:
8000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
9/19/1994
OSFM
First Notify Date:
3/31/1986
Abandoned Material:
Current Age:
22
Abandoned Date:
Install Date:
1/1/1972
Red Tag Issue Date:
Last Used Date:
9/19/1994
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 2
Capacity:
8000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
9/19/1994
OSFM
First Notify Date:
3/31/1986
Abandoned Material:
Current Age:
22
Abandoned Date:
Install Date:
1/1/1972
Red Tag Issue Date:
Last Used Date:
9/19/1994
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 3
Capacity:
8000
Petroleum Use:
Product:
Diesel Fuel
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
9/19/1994
OSFM
First Notify Date:
3/31/1986
Abandoned Material:
Current Age:
22
Abandoned Date:
Install Date:
1/1/1972
Red Tag Issue Date:
Last Used Date:
9/19/1994
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 4
Capacity:
4000
Petroleum Use:
Product:
Gasoline
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
9/19/1994
OSFM
First Notify Date:
3/31/1986
Abandoned Material:
Current Age:
22
Abandoned Date:
Install Date:
1/1/1972
Red Tag Issue Date:
Last Used Date:
9/19/1994
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 5
Capacity:
500
Petroleum Use:
Product:
Used Oil
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
Federal
Removed Date:
9/19/1994
OSFM
First Notify Date:
6/28/1994
Abandoned Material:
Current Age:
22
Abandoned Date:
Install Date:
1/1/1972
Red Tag Issue Date:
Last Used Date:
9/19/1994
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 6
Capacity:
500
Petroleum Use:
Consumptive Use on Premises for Heating
Product:
Heating Oil
CERCLA Substance:
Status:
Removed
CAS Code:
Regulated Status:
State
Removed Date:
9/19/1994
OSFM
First Notify Date:
6/28/1994
Abandoned Material:
Current Age:
22
Abandoned Date:
Install Date:
1/1/1972
Red Tag Issue Date:
Last Used Date:
9/19/1994
Fee Due:
$0.00
Product Date:
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank Number 7
Capacity:
10000
Petroleum Use:
Product:
Gasoline - Regular
CERCLA Substance:
Status:
Currently in use
CAS Code:
Regulated Status:
Federal
Removed Date:
OSFM
First Notify Date:
9/27/1994
Abandoned Material:
Current Age:
30
Abandoned Date:
Install Date:
9/23/1994
Red Tag Issue Date:
Last Used Date:
Fee Due:
$0.00
Product Date:
9/23/1994
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Corrosion Prot - Piping
Sacrificial Anode Flex Connector
3/25/2025
3/25/2028
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
3/25/2025
3/25/2026
Leak Detect - Tank
Automatic Tank Gauging Veeder Root EMC with CSLD
3/25/2025
3/25/2026
Overfill Prev Device
Overfill Drop Tube Valve
3/27/2024
3/27/2027
Piping
Flexible Double Wall
N/A
N/A
Piping
Single Wall STP/Tanktop Sump
Leak Detect - Piping
Piping Sump Sensors Not Regulated Not Installed
N/A
N/A
Spill Contain Device
Single Wall Spill Bucket
3/27/2024
3/27/2027
Tank
Fiberglass Double Wall
N/A
N/A
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Piping
Flexible Double Wall
Precision Test (Piping)
Pass
3/25/2025
Tank
Fiberglass Double Wall
Precision Test (Tank)
Pass
7/21/2020
Tank Number 8
Capacity:
6000
Petroleum Use:
Product:
Gasoline - Premium
CERCLA Substance:
Status:
Currently in use
CAS Code:
Regulated Status:
Federal
Removed Date:
OSFM
First Notify Date:
9/27/1994
Abandoned Material:
Current Age:
30
Abandoned Date:
Install Date:
9/23/1994
Red Tag Issue Date:
Last Used Date:
Fee Due:
$0.00
Product Date:
9/23/1994
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Corrosion Prot - Piping
Sacrificial Anode Flex Connector
3/25/2025
3/25/2028
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
3/25/2025
3/25/2026
Leak Detect - Tank
Automatic Tank Gauging Veeder Root EMC with CSLD
3/25/2025
3/25/2026
Overfill Prev Device
Overfill Drop Tube Valve
3/27/2024
3/27/2027
Piping
Flexible Double Wall
N/A
N/A
Piping
Single Wall STP/Tanktop Sump
Leak Detect - Piping
Piping Sump Sensors Not Regulated Not Installed
N/A
N/A
Spill Contain Device
Single Wall Spill Bucket
3/27/2024
3/27/2027
Tank
Fiberglass Double Wall
N/A
N/A
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Piping
Flexible Double Wall
Precision Test (Piping)
Pass
3/25/2025
Tank
Fiberglass Double Wall
Precision Test (Tank)
Pass
7/21/2020
Tank Number 9
Capacity:
4000
Petroleum Use:
None
Product:
Diesel Fuel
CERCLA Substance:
Status:
Currently in use
CAS Code:
Regulated Status:
Federal
Removed Date:
OSFM
First Notify Date:
9/27/1994
Abandoned Material:
Current Age:
30
Abandoned Date:
Install Date:
9/23/1994
Red Tag Issue Date:
Last Used Date:
Fee Due:
Product Date:
9/23/1994
Equipment
Equipment Type
Equipment
Last Passing Date
Test Expire Date
Corrosion Prot - Piping
Sacrificial Anode Flex Connector
3/25/2025
3/25/2028
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
3/25/2025
3/25/2026
Leak Detect - Tank
Automatic Tank Gauging Veeder Root EMC with CSLD
3/25/2025
3/25/2026
Overfill Prev Device
Overfill Drop Tube Valve
3/27/2024
3/27/2027
Piping
Flexible Double Wall
N/A
N/A
Piping
Single Wall STP/Tanktop Sump
Leak Detect - Piping
Piping Sump Sensors Not Regulated Not Installed
N/A
N/A
Spill Contain Device
Single Wall Spill Bucket
3/27/2024
3/27/2027
Tank
Fiberglass Double Wall
N/A
N/A
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Piping
Flexible Double Wall
Precision Test (Piping)
Pass
3/25/2025
Tank
Fiberglass Double Wall
Precision Test (Tank)
Pass
7/21/2020
Tank Number 10
Capacity:
500
Petroleum Use:
None
Product:
Used Oil
CERCLA Substance:
Status:
Currently in use
CAS Code:
Regulated Status:
Federal
Removed Date:
OSFM
First Notify Date:
9/27/1994
Abandoned Material:
Current Age:
30
Abandoned Date:
Install Date:
9/23/1994
Red Tag Issue Date:
Last Used Date:
Fee Due:
$0.00
Product Date:
9/23/1994
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
Gravity Feed
N/A
N/A
Leak Detect - Tank
110 - 600 gallons Manual Tank Gauging
N/A
N/A
Overfill Prev Device
Less than 25 gallon fills
N/A
N/A
Piping
Flexible Double Wall
N/A
N/A
Spill Contain Device
Single Wall Spill Bucket
3/27/2024
3/27/2027
Tank
Fiberglass Double Wall
N/A
N/A
Additional Tests
Equipment Type
Equipment
Test Type
Test Result
Test Date
Tank
Fiberglass Double Wall
Precision Test (Tank)
Pass
4/14/2022
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
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
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
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
MFD
Motorfuel Dispensing Forms
No Forms Found
