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State of California— California Environmental Protection Agency Department of Toxic Substances Control <br />P.O. Box 806 <br />Sacramento, CA 95812-0806 <br />California Hazardous Waste Permanent ID Number Application <br />Please review the instructions carefully and complete all items on the application. <br />1. Application for a permanent California ID number as a: 5d Generator -1 Transporter -1 Both <br />2. This site is a: -1 Large Quantity Generator �V Small Quantity Generator <br />3. Change in previously issued ID number: <br />�4 Inactivate -1 Reactivate ID Number: C L 00 00 (0 O -7 Z- <br />4. <br />4. Site/Facility Name: ICRE/YIDA -r c5h—c--LL <br />5. Site Location: �/ °1 �-1 E F-KCA 7 O M 7— <br />Street <br />67DCK 7-0^J (7A �!5-20S— —9N Xq AJ <br />City State Zip County <br />6. Mailing Address: -;2 L/ y y E FI?E7W 0" 7— <br />Street Street <br />57aC K -r0 ti/ e p 95 -?- <br />City State Zip <br />7. Site Contact Person: M I N A -EL J6 rVt l AI (2 u Eo <br />First Name Last Name <br />Contact Person Address: 2-qq -I e /r�QElnDA1 7— <br />Street <br />67'bCK7a^J CA 95-ZO5— <br />City State Zip <br />Contact Person Phone Number: (ab`n &CI - 709'2- Fax Number: ( ) <br />Area Code Phone Number Area Code Fax Number <br />Contact Person Business Email Address: <br />Preferred Primary Communication: )e Mail <br />Email <br />8. Legal Owner: YVt t C 1`> CZ Z?p m 1 nJ 4 u 6 -7 <br />Name <br />Owner Address: 2qi,/ E G1ee7nON7" 57DCk7D/1 CP <br />Street City State Zip <br />Owner Phone Number: (,�s <br />Area Code Phone Number <br />9. Standard Industrial Classification (SIC) Code for the Site: { ( (4 -Digit Number) <br />DTSC 1358 04/02/2003 <br />