Division of Petroleum & Chemical Safety

 

Facility Details

Facility Number: 2021290
Status: Active
Facility Name: LaGrange Memorial Hospital
Address: 5101 South Willow Springs Road
La Grange, IL 60525
County: Cook
Property Parcel:
Facility Type: Private Institution
Owner Type: Private
Green Tag Decal: Z003448
Green Tag Issue Date: 1/31/2024
Green Tag Expiration Date: 12/31/2026

Owner Details

Owner Name: LaGrange Memorial Hospital
Owner Address: 5101 South Willow Springs Road
La Grange, IL 60525
Owner Status: Current Owner
Purchase Date: 1/1/1987
Type of Financial Responsibility: Commercial Insurance
Financial Responsibility Reporting Due Date: 1/31/2025

Motor Fuel Dispensing Permits

No MFD Permits Found

Owner Summary

Click for Facility/Tank Ownership history
Owner Number Owner Name Owner Status Purchase Date
U0008740 LaGrange Memorial Hospital Current Owner 1/1/1987

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
04-0084 2/25/2004 Removal Log 04162-2004REM
04-0178 8/5/2004 Removal Log 04246-2004REM

LUST Fund Eligibility and Deductibility Determinations

IEMA Number Status OSFM Received Date OSFM Response Date Deductible Letter
90-2391 Eligible 12/1/1993 12/20/1993 $10,000
04-0084 Eligible 1/27/2004 2/11/2004 $10,000
04-0178 Eligible 2/17/2004 2/26/2004 $10,000
Pay Tank Fees Online

Tank Information



Tank Number 1

Capacity: 15000 Petroleum Use: Back-up Generator
Product: Diesel Fuel CERCLA Substance:
Status: Removed CAS Code:
Regulated Status: Federal Removed Date: 2/24/2004
OSFM First Notify Date: 4/15/1986 Abandoned Material:
Current Age: 24 Abandoned Date:
Install Date: 10/10/1979 Red Tag Issue Date:
Last Used Date: 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: 15000 Petroleum Use: Back-up Generator
Product: Diesel Fuel CERCLA Substance:
Status: Removed CAS Code:
Regulated Status: Federal Removed Date: 2/24/2004
OSFM First Notify Date: 4/15/1986 Abandoned Material:
Current Age: 24 Abandoned Date:
Install Date: 10/10/1979 Red Tag Issue Date:
Last Used Date: 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: 15000 Petroleum Use: Back-up Generator
Product: Diesel Fuel CERCLA Substance:
Status: Removed CAS Code:
Regulated Status: Federal Removed Date: 2/24/2004
OSFM First Notify Date: 4/15/1986 Abandoned Material:
Current Age: 24 Abandoned Date:
Install Date: 10/10/1979 Red Tag Issue Date:
Last Used Date: 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: 12000 Petroleum Use: Back-up Generator
Product: Diesel Fuel CERCLA Substance:
Status: Removed CAS Code:
Regulated Status: Federal Removed Date: 8/5/2004
OSFM First Notify Date: 11/19/1987 Abandoned Material:
Current Age: 16 Abandoned Date:
Install Date: 1/1/1987 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 9/18/1987

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: 12000 Petroleum Use: Back-up Generator
Product: Diesel Fuel CERCLA Substance:
Status: Removed CAS Code:
Regulated Status: Federal Removed Date: 8/5/2004
OSFM First Notify Date: 11/19/1987 Abandoned Material:
Current Age: 16 Abandoned Date:
Install Date: 1/1/1987 Red Tag Issue Date:
Last Used Date: 3/1/2000 Fee Due: $0.00
Product Date: 9/18/1987

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: 12000 Petroleum Use: Back-up Generator
Product: Diesel Fuel CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 4/23/2004 Abandoned Material:
Current Age: 21 Abandoned Date:
Install Date: 1/27/2004 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 1/28/2004

Equipment

Equipment Type Equipment Last Passing Date Test Expire Date
Corrosion Prot - Piping Composite Secondary Containment N/A N/A
Corrosion Prot - Tank Fiberglass Non-Corrosive N/A N/A
Leak Detect - Piping Mechanical Pressurized Line Leak Detection 9/4/2024 9/4/2025
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 350 Plus 9/4/2024 9/4/2025
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 9/4/2024 9/4/2025
Overfill Prev Device Overfill Drop Tube Valve 10/24/2022 10/24/2025
Piping Composite Chase N/A N/A
Piping Steel Single Wall Piping N/A N/A
Piping Single Wall STP/Tanktop Sump 10/24/2022 10/24/2025
Leak Detect - Piping Sump Sensor 9/4/2024 9/4/2025
Spill Contain Device Single Wall Spill Bucket 10/24/2022 10/24/2025
Tank Fiberglass Double Wall XERXES N/A N/A
Vent, Riser, Fill Piping Steel risers N/A N/A

Additional Tests

Equipment Type Equipment Test Type Test Result Test Date
Piping Steel Single Wall Piping Precision Test (Piping) Pass 9/4/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors Sensor Functional Pass 5/7/2006
Leak Detect - Piping Non-Discriminating Sump Sensor Sensor Functional Pass 5/7/2006



Tank Number 7

Capacity: 12000 Petroleum Use: Back-up Generator
Product: Diesel Fuel CERCLA Substance:
Status: Currently in use CAS Code:
Regulated Status: Federal Removed Date:
OSFM First Notify Date: 4/23/2004 Abandoned Material:
Current Age: 21 Abandoned Date:
Install Date: 1/27/2004 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 1/28/2004

Equipment

Equipment Type Equipment Last Passing Date Test Expire Date
Corrosion Prot - Piping Composite Secondary Containment N/A N/A
Corrosion Prot - Tank Fiberglass Non-Corrosive N/A N/A
Leak Detect - Piping Mechanical Pressurized Line Leak Detection 9/4/2024 9/4/2025
Leak Detect - Tank Automatic Tank Gauging Veeder Root TLS 350 Plus 9/4/2024 9/4/2025
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors 9/4/2024 9/4/2025
Overfill Prev Device Overfill Drop Tube Valve 10/24/2022 10/24/2025
Piping Composite Chase N/A N/A
Piping Steel Single Wall Piping N/A N/A
Piping Single Wall STP/Tanktop Sump 10/24/2022 10/24/2025
Leak Detect - Piping Sump Sensor 9/4/2024 9/4/2025
Spill Contain Device Single Wall Spill Bucket 10/24/2022 10/24/2025
Tank Fiberglass Double Wall XERXES N/A N/A
Vent, Riser, Fill Piping Steel risers N/A N/A

Additional Tests

Equipment Type Equipment Test Type Test Result Test Date
Piping Steel Single Wall Piping Precision Test (Piping) Pass 9/4/2024
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors Sensor Functional Pass 5/7/2006
Leak Detect - Piping Non-Discriminating Sump Sensor Sensor Functional Pass 5/7/2006

Dispenser Information



MFD Motorfuel Dispensing Forms

No Forms Found