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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

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Facility Details

Facility Number:	2046235
Status:	Active
Facility Name:	Sam's Club #8184
Address:	6570 Grand Avenue Gurnee, IL 60031
County:	Lake
Property Parcel:	07-08-401-095
Facility Type:	Attended Self-Service Station
Owner Type:	Private
Green Tag Decal:	Z000722
Green Tag Issue Date:	2/26/2024
Green Tag Expiration Date:	12/31/2026

Owner Details

Owner Name:	Sam's West, Inc.
Owner Address:	2101 SE Simple Savings Drive Bentonville, AR 727160745
Owner Status:	Current Owner
Purchase Date:
Type of Financial Responsibility:	Commercial Insurance
Financial Responsibility Reporting Due Date:	4/29/2025

Motor Fuel Dispensing Permits

MFD Permit Type	Issue Date	Expiration Date
Self Service	2/26/2024	12/31/2026

Owner Summary

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Owner Number	Owner Name	Owner Status	Purchase Date
U0029973	Sam's West, Inc.	Current Owner

Permits (Unexpired)

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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	Capacity	Product	Status	Regulated Status	Red Tag Issued	Fee Due	Abandon/Removal Date
1	20000	Gasoline - Regular	Currently in use	Federal		$0.00
2	20000	Gasoline - Regular	Currently in use	Federal		$0.00
3	12000	Gasoline - Premium	Currently in use	Federal		$0.00
4	8000	Diesel Fuel	Currently in use	Federal		$0.00

Dispenser Information

Name\ID	Status
1/2	Active
3/4	Active
5/6	Active
7/8	Active
9/10	Active
11/12	Active

MFD Motorfuel Dispensing Forms

Facility Number	Name	City	Received Date	Letter
2046235	Sam's Club #8184	Gurnee	12/12/2016	Letter Form
2046235	Sam's Club #8184	Gurnee	09/08/2016	Form
2046235	Sam's Club #8184	Gurnee	09/08/2016	Form