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:	2040745
Status:	Closed
Facility Name:	Dominicks #1958
Address:	1296 South Route 12 Fox Lake, IL 60020
County:	Lake
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	N000075
Green Tag Issue Date:	4/17/2012
Green Tag Expiration Date:	12/31/2014

Owner Details

Owner Name:	Safeway, Inc.
Owner Address:	5918 Stoneridge Mall Rd. Pleasanton, CA 94588
Owner Status:	Current Owner
Purchase Date:	2/11/2002
Type of Financial Responsibility:
Financial Responsibility Reporting Due Date:

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	1/24/2012	12/31/2014

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0037127	Safeway, Inc.	Current Owner	2/11/2002
U0034797	Safeway/Domnicks Finer Foods	Former Owner
U0004179	Dominick's Finer Foods, Inc.	Former Owner

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

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		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	8/18/2014
OSFM First Notify Date:	4/15/2002		Abandoned Material:
Current Age:	12		Abandoned Date:
Install Date:	2/11/2002		Red Tag Issue Date:
Last Used Date:	12/28/2013		Fee Due:	$0.00
Product Date:	3/28/2002

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Jacketed Steel Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	3/20/2012	3/20/2013
Leak Detect - Piping	Sump Sensor	3/20/2012	3/20/2013
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350R with CSLD
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	3/20/2012	3/20/2013
Overfill Prev Device	Overfill Alarm
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Flexible Double Wall Western Co-Flex	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket
Tank	Composite Double Wall Glasteel II	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 2

Capacity:	10000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	8/18/2014
OSFM First Notify Date:	4/15/2002		Abandoned Material:
Current Age:	12		Abandoned Date:
Install Date:	2/11/2002		Red Tag Issue Date:
Last Used Date:	12/28/2013		Fee Due:	$0.00
Product Date:	3/28/2002

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Jacketed Steel Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	3/20/2012	3/20/2013
Leak Detect - Piping	Sump Sensor	3/20/2012	3/20/2013
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350R with CSLD
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	3/20/2012	3/20/2013
Overfill Prev Device	Overfill Alarm
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Flexible Double Wall Western Co-Flex	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket
Tank	Composite Double Wall Glasteel II	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Tank Number 3

Capacity:	10000		Petroleum Use:
Product:	Gasoline		CERCLA Substance:
Status:	Removed		CAS Code:
Regulated Status:	Federal		Removed Date:	8/18/2014
OSFM First Notify Date:	4/15/2002		Abandoned Material:
Current Age:	12		Abandoned Date:
Install Date:	2/11/2002		Red Tag Issue Date:
Last Used Date:	12/28/2013		Fee Due:	$0.00
Product Date:	3/28/2002

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Flexible Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Jacketed Steel Non-Corrosive	N/A	N/A
Leak Detect - Piping	Electronic Pressurized Line Leak Detection	3/20/2012	3/20/2013
Leak Detect - Piping	Sump Sensor	3/20/2012	3/20/2013
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 350R with CSLD
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors	3/20/2012	3/20/2013
Overfill Prev Device	Overfill Alarm
Overfill Prev Device	Overfill Drop Tube Valve
Piping	Flexible Double Wall Western Co-Flex	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket
Tank	Composite Double Wall Glasteel II	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Dispenser Information

MFD Motorfuel Dispensing Forms

No Forms Found