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Please print or Noe. (Form designed for use nn altte 112-nlfrht w„awriror � <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />121. Generator ID Number <br />22. Page <br />t-orMApproved. oMS No. 2050.0039 <br />23. Manliest Tracking Number <br />(Continuation Sheet) <br />CA2890090002 <br />4 <br />005870331 JJK <br />24. Generators Name Lawrence Livermore National Laboratory Site 300 for NNSA <br />P.O. Box 8081 L-7a6� ' <br />Livermore CA 94551 <br />25. Transporter Company Name U.S. EPA ID Number JAN 14 ZU1b <br />25. Transporter Company Name U.S. EPA ID Number <br />CNS- IRflN'VI f=NTAL <br />-err <br />27a. <br />27b. U.S. DOT Desatption Qnduding Proper Shipping Name, Hazard Class, ID Number, <br />26. Containers <br />2g. Total <br />30. Untt L., <br />HM <br />and Packing Group Of any)) <br />Quantity <br />WI./Vol. <br />31. Waste Codes <br />No. <br />Type <br />25. Non-RCRA hazardous waste, liquid (photo replenisher) <br />(DOP01210-1) <br />1 <br />DF <br />70 <br />P <br />26. Non-RCRA hazardous waste, liquid (spent antifreeze) <br />(DOP0010-1) <br />343 <br />2 <br />DTs <br />005 <br />P <br />27. Non-RGRA hazardous waste, liquid (spent antifreeze) <br />(DOP0010-1) <br />343 <br />1 <br />OF <br />41 <br />P <br />a <br />pft- 0 (S <br />29. Non-RCRA hazardous waste, liquid (water contaminated with <br />diesel) (DOP0010-1) <br />133 <br />1 <br />DF <br />45 <br />P <br />30. Non-RCRA hazardous waste, liquid (water contaminated with <br />ethyl acetate) (DOP0010-1) <br />1 <br />DTs <br />44 <br />P <br />134 <br />31. Non-RCRA hazardous waste, liquid (water contarlvnated with <br />petroleum hydrocarbons oil) (DOP0010-1) <br />i <br />DM <br />451 <br />P <br />223 <br />32. Non-RCRA hazardous waste, liquid (water contaminated with <br />petroleum hydrocarbons) (DOPI]010-1) <br />1 <br />IDN <br />416 <br />P <br />223 <br />33. Non-RCRA hazardous waste, liquid (water contaminated with <br />134 <br />sodium citrate) (DO13001 D-1) <br />1 <br />DF <br />27 <br />P <br />34. Non-RCP.A hazardous waste, solid (adhesive, sealant) <br />331 <br />(DOP0120-1) <br />1 <br />DF <br />ii <br />P <br />32. Special Handling Instructions and AdddorW information <br />33. Transporter Acknowledgment of Receipt of Materials <br />12 <br />Pdnte&Typed Name Signature Month Day Year <br />cd <br />O <br />a <br />Z <br />34. Transporter Acknowledgment of Receipt of Materials <br />PrintedrTyped Name Signature Month Day Year <br />f- <br />35. Discrepancy <br />7 <br />Q <br />C <br />w <br />Q <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling sys(ems) <br />t7 <br />rn <br />w <br />0 <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />