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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />Fnrm Annmvpd nMR Nn )nrrLnnw <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST Generator ID Number <br />22. Page <br />23, Manifest Tracking Number <br />121. <br />(Cont►nuadon Sheet) CA2890090002 <br />6 <br />005870331 JJK <br />4. Generators Name Lawrence Lhrermore National l.30oratory Stte 300 for NnISA ,.,�.. E <br />P.O. Box 808 I L-786 <br />Ltaermore CA 94551 <br />25. Transporter Company Name U.S. EPA ID Number 1 <br />Transporter Company Name bar <br />28. TransporterU.S. EPA ID Num <br />(rinNMF_NTAL <br />27a. <br />27b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />28. Contalners <br />29. Total t i <br />1 L Unit <br />v <br />HM <br />and Paddng Group (darty)) <br />Quantity <br />WNrd. <br />31. Waste Codes <br />No. <br />Type <br />45. Non-RCRA hazardous waste, solid (grease, sealant) <br />rDOp012a1) <br />i <br />DF <br />i0 <br />P <br />33). <br />48. Non-RCRA hazardous waste, solid (non PCD capacitors) <br />(DOP0028-1) <br />i <br />OF <br />28 <br />P <br />223 <br />47. Non-RCRA hazardous waste, solid (non -PCS capacitors) <br />(DOP0029-1) <br />3 <br />OF <br />95 <br />P <br />223 <br />a <br />48. Non-RCRA hazardous haste, solid (non -PCB capacitors) <br />(DOP0029-1) <br />1 <br />i� <br />243 <br />e <br />q223 <br />w <br />z <br />LU <br />49. Nan-RCRA hazardous waste, solid (tags contaminated with <br />petroleum hydrocarbons) (DOP0044-1) <br />i <br />ON <br />175 <br />P <br />50. Non-RCRA hazardous waste, solid (rags contaminated with <br />penleum hydrocarbons) (DOP0044-1) <br />1 <br />DM <br />137 <br />P <br />223 <br />51. Non-RCRA hazardous waste, solid (soil contaminated with <br />223 <br />petroleum hydrocarbons) (DOP0104-1) <br />i <br />1DM <br />198 <br />P <br />52. Non-RCRA hazardous waste, solid (used fuel filters) <br />223 <br />(DOP0044-1) <br />1 <br />OF <br />16 <br />P <br />53. Non-RCRA hazardous waste, solid (used oil filters) (DOP0044- <br />223 <br />1) <br />1 <br />DF <br />33 <br />P <br />54. Non-RCRA hazardous waste, solid (used oil filters) (DOP0044- <br />223 <br />1) <br />1 <br />OF <br />6 <br />P <br />32. Special Handling Instructonsand Additional Informatlon <br />33. Transporter AdmWedgment of Recot of Materials <br />�+ <br />Pdntedrryped Name Signature Month Day Year <br />cc <br />O <br />a <br />rn <br />34. Tra rW Adowwled ment of Rece t of Materials <br />Printedrryped Name Signature Month Day Year <br />H <br />35. Discrepancy <br />J <br />v <br />0 <br />Q38. <br />Hazardous Waste Report Management MaUM Codes (i.e., codes for hazardous waste treatment, (fisposal, and recyd;ng systems) <br />C9 <br />to <br />W <br />D <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />