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wwd STATE ID NUMBER 0000013082001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />( 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT ) 07 TANKS ( 1 09 DELETE FROV FILE (NO FEE) <br />( ] 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT R CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY:)NOZ: <br />LY <br />HOLLY SUGAR CORPORATION ( ) B1 FED f STATff 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />100 CHASE STONE CENTER COLORADO SPRINGS CO 80903 <br />11 rn�ll.l„ <br />EMERGENCY CONTACT <br />PERSON <br />VVI\JI ....,. <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />NAME FIRST) AND PHONE W/AREA <br />CODE <br />FACILITY NAME <br />NIGHTS: <br />LOUIS R. GARCIA, JR. <br />FIRST) AND PHONE W/A <br />!A CODE <br />HOLLY SUGAR CORPORATION <br />JR. 209-835-3210 <br />YEAR MFG: <br />C. YEAR INSTALLED <br />GARCIA, <br />LOUIS R. JR. <br />209-835-8216 <br />B. <br />(X) <br />D. <br />CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN <br />NEAREST CROSS STREET <br />CONTAINER STORE: ( ) 01 WASTE (X) 02 <br />PRO <br />STREET ADDRESS <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />( 1 01 UNLEADED (X) 02 REGULAR t ) 03 PREMIUM ( 1 04 DIESEL <br />01 YES f ) 02 NO IF YES CHECK APPR <br />t ) 05 WASTE OIL [ 1 06 OTHER <br />RI <br />20,500 HOLLY DRIVE <br />LARCH ROAD <br />C. <br />( ) <br />01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED <br />COUNTY <br />IIP <br />CITY <br />(X) <br />( <br />SAN JOAQUIN <br />CARBON STEEL ( l 02 STAINLESS STEEL <br />06 ALUMINUM ( 1 07 STEEL CLAD ( 1 <br />953 <br />6 <br />TRACY <br />( ) <br />12 <br />UNKNOWN ( ) 13 OTHER- <br />CITY <br />STATE <br />IP <br />MAILING ADDRESS <br />CA <br />95376 <br />P. 0. BOX 60 <br />TRACY <br />PHONEW/AREA CODE <br />TYPE OF BUSINESS <br />STATION (X) 02 OTHER SUGAR <br />MANUFACTURING <br />- <br />209-835-3210 <br />l ) 01 GASOLINE <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY : <br />TOWNSHIP <br />RANGE <br />SECTION <br />2 <br />III 24 HOUR <br />EMERGENCY CONTACT <br />PERSON <br />VVI\JI ....,. <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />DAYS: NAME(LAST <br />NAME FIRST) AND PHONE W/AREA <br />CODE <br />OF PRIMARY CONTAINMENT: 10 <br />NIGHTS: <br />NAME(LAST NAME <br />FIRST) AND PHONE W/A <br />!A CODE <br />GARCIA, LOUIS. R. <br />JR. 209-835-3210 <br />YEAR MFG: <br />C. YEAR INSTALLED <br />GARCIA, <br />LOUIS R. JR. <br />209-835-8216 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />1V <br />DESCKlr i lull <br />VVI\JI ....,. <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />CONTAINER NUMBER 61 <br />THICKNESS <br />OF PRIMARY CONTAINMENT: 10 <br />(X) GAUGE <br />( ) INCHES ( <br />) CM ( 1 UNKNOWN <br />B. <br />MANUFACTURER (IF APPROPRIATE): UNKNOWN <br />YEAR MFG: <br />C. YEAR INSTALLED <br />ABOX(ES): <br />B. <br />(X) <br />D. <br />CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( ) 01 WASTE (X) 02 <br />PRO <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />( 1 01 UNLEADED (X) 02 REGULAR t ) 03 PREMIUM ( 1 04 DIESEL <br />01 YES f ) 02 NO IF YES CHECK APPR <br />t ) 05 WASTE OIL [ 1 06 OTHER <br />RI <br />u <br />V <br />CUIV9n11!CN <br />VVI\JI ....,. <br />A. <br />THICKNESS <br />OF PRIMARY CONTAINMENT: 10 <br />(X) GAUGE <br />( ) INCHES ( <br />) CM ( 1 UNKNOWN <br />B. <br />(X) <br />01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 1 02 <br />NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED <br />t 1 03 LINED <br />D. <br />(X) <br />( <br />01 <br />) <br />CARBON STEEL ( l 02 STAINLESS STEEL <br />06 ALUMINUM ( 1 07 STEEL CLAD ( 1 <br />( 1 03 FIBERGLASS ( 1 04 <br />08 BRONZE ( 1 09 COMPOSITE <br />POLYVINYL CHLORIDE f ) 05 CO <br />l ) 10 NON-METALLIC <br />CRETE <br />( ) <br />12 <br />UNKNOWN ( ) 13 OTHER- <br />HSC04-070185 (10/18/85) <br />0 • I <br />