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:	7044887
Status:	Active
Facility Name:	SSM Health Good Samaritan Hospital
Address:	1 Good Samaritan Way Mount Vernon, IL 62864
County:	Jefferson
Property Parcel:
Facility Type:	Hospital
Owner Type:	Private
Green Tag Decal:	Z003826
Green Tag Issue Date:	6/4/2024
Green Tag Expiration Date:	12/31/2026

Owner Details

Owner Name:	SSM Health Good Samaritan Hospital
Owner Address:	1 Good Samaritan Way Mount Vernon, IL 62864
Owner Status:	Current Owner
Purchase Date:	8/24/2015
Type of Financial Responsibility:	Commercial Insurance
Financial Responsibility Reporting Due Date:	7/11/2025

Motor Fuel Dispensing Permits

No MFD Permits Found

Owner Summary

Click for Facility/Tank Ownership history

Owner Number	Owner Name	Owner Status	Purchase Date
U0038414	SSM Health Good Samaritan Hospital	Current Owner	8/24/2015
U0036084	St. Mary's Good Samaratin Medical Center	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:	50000		Petroleum Use:	Back-up Generator
Product:	Diesel Fuel		CERCLA Substance:
Status:	Currently in use		CAS Code:
Regulated Status:	Federal		Removed Date:
OSFM First Notify Date:	10/9/2012		Abandoned Material:
Current Age:	13		Abandoned Date:
Install Date:	1/9/2012		Red Tag Issue Date:
Last Used Date:			Fee Due:
Product Date:	1/10/2012

Equipment

Equipment Type	Equipment	Last Passing Date	Test Expire Date
Corrosion Prot - Piping	Fiberglass Non-Corrosive	N/A	N/A
Corrosion Prot - Tank	Composite Non-Corrosive	N/A	N/A
Leak Detect - Piping	American with Sensors/No Test Suction	N/A	N/A
Leak Detect - Tank	Automatic Tank Gauging Veeder Root TLS 300c	4/25/2024	4/25/2025
Leak Detect - Tank	Hydrostatic Reservoir Interstitial Monitoring Sensors	4/25/2024	4/25/2025
Manway At Grade	Accessible Manway Accessible at Grade	N/A	N/A
Overfill Prev Device	Overfill Drop Tube Valve	5/4/2022	5/4/2025
Piping	Fiberglass Double Wall Ameron Dualoy 3000/LCX	N/A	N/A
Piping	Single Wall STP/Tanktop Sump
Leak Detect - Piping	Piping Sump Sensors Not Regulated	N/A	N/A
Spill Contain Device	Single Wall Spill Bucket	5/4/2022	5/4/2025
Tank	Composite Double Wall Modern Welding Glasteel II	N/A	N/A
Vent, Riser, Fill Piping	Steel risers	N/A	N/A

Additional Tests

Equipment Type	Equipment	Test Type	Test Result	Test Date
Leak Detect - Piping	American with Sensors/No Test Suction	Functional	Pass	4/25/2024

Dispenser Information

MFD Motorfuel Dispensing Forms

No Forms Found