Information
JB Pritzker, Governor

James A. Rivera, State Fire Marshal

Division of Petroleum & Chemical Safety
State of Illinois
Employment Opportunities
Ready Illinois
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Division of Petroleum & Chemical Safety

 

Facility Details

Facility Number: 2046672
Status: Active
Facility Name: Sam's Club #6489
Address: 603 River Oaks West
Calumet City, IL 60148
County: Cook
Property Parcel:
Facility Type: Attended Self-Service Station
Owner Type: Private
Green Tag Decal: Z001288
Green Tag Issue Date: 5/9/2024
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 5/9/2024 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: 12/13/2018 Abandoned Material:
Current Age: 6 Abandoned Date:
Install Date: 9/20/2018 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/5/2018

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 10/1/2024 10/1/2025
Leak Detect - Piping Siphon Bar N/A N/A
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 10/1/2024 10/1/2025
Overfill Prev Device Overfill Drop Tube Valve 10/1/2024 10/1/2027
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025
Spill Contain Device Double Wall Spill Bucket 10/1/2024 10/1/2027
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 10/1/2024
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 10/5/2023



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: 12/13/2018 Abandoned Material:
Current Age: 6 Abandoned Date:
Install Date: 9/20/2018 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/5/2018

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 10/1/2024 10/1/2025
Leak Detect - Piping Siphon Bar N/A N/A
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 10/1/2024 10/1/2025
Overfill Prev Device Overfill Drop Tube Valve 10/1/2024 10/1/2027
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025
Spill Contain Device Double Wall Spill Bucket 10/1/2024 10/1/2027
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 10/1/2024
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 10/5/2023



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: 12/13/2018 Abandoned Material:
Current Age: 6 Abandoned Date:
Install Date: 9/20/2018 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/5/2018

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 4/23/2025 4/23/2026
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 10/1/2024 10/1/2025
Overfill Prev Device Overfill Drop Tube Valve 10/1/2024 10/1/2027
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025
Spill Contain Device Double Wall Spill Bucket 10/1/2024 10/1/2027
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 10/1/2024
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 10/5/2023



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: 12/13/2018 Abandoned Material:
Current Age: 6 Abandoned Date:
Install Date: 9/20/2018 Red Tag Issue Date:
Last Used Date: Fee Due: $0.00
Product Date: 12/5/2018

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 10/1/2024 10/1/2025
Leak Detect - Tank Non-Discriminating Interstitial Monitoring Sensors With Monitor 10/1/2024 10/1/2025
Overfill Prev Device Overfill Drop Tube Valve 10/1/2024 10/1/2027
Piping Flexible Double Wall OPW Flexworks N/A N/A
Piping Single Wall STP/Tanktop Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025
Spill Contain Device Double Wall Spill Bucket 10/1/2024 10/1/2027
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 10/1/2024
Tank Fiberglass Double Wall XERXES Precision Test (Tank) Pass 10/5/2023

Dispenser Information



Name\ID 1/2

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025



Name\ID 11/12

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025



Name\ID 13/14

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025



Name\ID 15/16

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025



Name\ID 3/4

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025



Name\ID 5/6

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025



Name\ID 7/8

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025



Name\ID 9/10

Status: Active
Equipment Type Equipment Last Passing Date Test Expire Date
Dispenser Single Wall UDC Sump 9/3/2024 9/3/2027
Leak Detect - Piping Sump Sensor with positive shutdown 10/1/2024 10/1/2025

MFD Motorfuel Dispensing Forms

No Forms Found

Office of the Illinois State Fire Marshal
1035 Stevenson Dr. Springfield, IL 62704 | (217) 785-0969 | Contact Us