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:	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:	4/29/2026

Motor Fuel Dispensing Permits

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

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0029973	Sam's West, Inc.	Current 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 - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	12/13/2016		Abandoned Material:
Current Age:	8		Abandoned Date:
Install Date:	9/15/2016		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/30/2016

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	7/17/2024	7/17/2025
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors With Monitor	8/26/2024	8/26/2025
Overfill Prev Device	Overfill Drop Tube Valve	9/14/2022	9/14/2025
Piping	Flexible Double Wall OPW Flexworks	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	7/17/2024	7/17/2025
Spill Contain Device	Double Wall Spill Bucket	7/17/2024	7/17/2027
Tank	Fiberglass Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall OPW Flexworks	Precision Test (Piping)	Pass	7/17/2024
Tank	Fiberglass Double Wall XERXES	Precision Test (Tank)	Pass	9/28/2021

Tank Number 2

Capacity:	20000		Petroleum Use:
Product:	Gasoline - Regular		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	12/13/2016		Abandoned Material:
Current Age:	8		Abandoned Date:
Install Date:	9/15/2016		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/30/2016

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	7/17/2024	7/17/2025
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors With Monitor	8/26/2024	8/26/2025
Overfill Prev Device	Overfill Drop Tube Valve	9/14/2022	9/14/2025
Piping	Flexible Double Wall OPW Flexworks	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	7/17/2024	7/17/2025
Spill Contain Device	Double Wall Spill Bucket	7/17/2024	7/17/2027
Tank	Fiberglass Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall OPW Flexworks	Precision Test (Piping)	Pass	7/17/2024
Tank	Fiberglass Double Wall XERXES	Precision Test (Tank)	Pass	9/28/2021

Tank Number 3

Capacity:	12000		Petroleum Use:
Product:	Gasoline - Premium		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	12/13/2016		Abandoned Material:
Current Age:	8		Abandoned Date:
Install Date:	9/15/2016		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/30/2016

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	7/17/2024	7/17/2025
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors With Monitor	8/26/2024	8/26/2025
Overfill Prev Device	Overfill Drop Tube Valve	9/14/2022	9/14/2025
Piping	Flexible Double Wall OPW Flexworks	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	7/17/2024	7/17/2025
Spill Contain Device	Double Wall Spill Bucket	7/17/2024	7/17/2027
Tank	Fiberglass Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall OPW Flexworks	Precision Test (Piping)	Pass	7/17/2024
Tank	Fiberglass Double Wall XERXES	Precision Test (Tank)	Pass	9/28/2021

Tank Number 4

Capacity:	8000		Petroleum Use:
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	12/13/2016		Abandoned Material:
Current Age:	8		Abandoned Date:
Install Date:	9/15/2016		Red Tag Issue Date:
Last Used Date:			Fee Due:	$0.00
Product Date:	11/30/2016

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	7/17/2024	7/17/2025
Leak Detect - Tank	Non-Discriminating Interstitial Monitoring Sensors With Monitor	7/17/2024	7/17/2025
Overfill Prev Device	Overfill Drop Tube Valve	9/14/2022	9/14/2025
Piping	Flexible Double Wall OPW Flexworks	N/A	N/A
Piping	Single Wall STP/Tanktop Sump	9/6/2022	9/6/2025
Leak Detect - Piping	Sump Sensor with positive shutdown	7/17/2024	7/17/2025
Spill Contain Device	Double Wall Spill Bucket	7/17/2024	7/17/2027
Tank	Fiberglass Double Wall XERXES	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Piping	Flexible Double Wall OPW Flexworks	Precision Test (Piping)	Pass	7/17/2024
Tank	Fiberglass Double Wall XERXES	Precision Test (Tank)	Pass	9/28/2021

Dispenser Information

Name\ID 1/2

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor	7/17/2024	7/17/2025

Name\ID 11/12

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor	7/17/2024	7/17/2025

Name\ID 3/4

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor	7/17/2024	7/17/2025

Name\ID 5/6

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor	7/17/2024	7/17/2025

Name\ID 7/8

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor	7/17/2024	7/17/2025

Name\ID 9/10

Status:	Active

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Dispenser	Single Wall UDC Sump	8/12/2022	8/12/2025
Leak Detect - Piping	Sump Sensor	7/17/2024	7/17/2025

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