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:	2040791
Status:	Closed
Facility Name:	Sam's Club Fueling Station #8154
Address:	21430 S. Cicero Ave. Matteson, IL 60443
County:	Cook
Property Parcel:
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	R006178
Green Tag Issue Date:	3/7/2016
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:	3/7/2002
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	3/7/2016	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	3/7/2002
U0017352	Wal-Mart Stores, Inc.	Former Owner	3/7/2002

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

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:	6/28/2018
OSFM First Notify Date:	4/29/2002		Abandoned Material:
Current Age:	16		Abandoned Date:
Install Date:	3/7/2002		Red Tag Issue Date:
Last Used Date:	1/26/2018		Fee Due:	$0.00
Product Date:	3/7/2002

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	10/27/2015	10/27/2016
Leak Detect - Piping	Sump Sensor	10/27/2015	10/27/2016
Leak Detect - Tank	Automatic Tank Gauging OPW EECO 2000 with CITLDS
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 XERXES	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:	6/28/2018
OSFM First Notify Date:	4/29/2002		Abandoned Material:
Current Age:	16		Abandoned Date:
Install Date:	3/7/2002		Red Tag Issue Date:
Last Used Date:	1/26/2018		Fee Due:	$0.00
Product Date:	3/7/2002

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	10/27/2015	10/27/2016
Leak Detect - Piping	Sump Sensor	10/27/2015	10/27/2016
Leak Detect - Tank	Automatic Tank Gauging OPW EECO 2000 with CITLDS
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 XERXES	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:	6/28/2018
OSFM First Notify Date:	4/29/2002		Abandoned Material:
Current Age:	16		Abandoned Date:
Install Date:	3/7/2002		Red Tag Issue Date:
Last Used Date:	1/26/2018		Fee Due:	$0.00
Product Date:	3/7/2002

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	10/27/2015	10/27/2016
Leak Detect - Piping	Sump Sensor	10/27/2015	10/27/2016
Leak Detect - Tank	Automatic Tank Gauging OPW EECO 2000 with CITLDS
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 XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date

Dispenser Information

MFD Motorfuel Dispensing Forms

No Forms Found