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<br />of California—Environmental Protection Agency
<br />Approved OMB No. 2050-0039 (Expires 9.30.99) See Instructions on back of page .. Department of Toxic Substances Control
<br />t ori nt or bype. farm designed for use on elite f 12-pikhf typewriter. Sacramento, California
<br />DO NOT WRITE E� THIS LINE.
<br />DTSC 8022A (1/99( While: TSDF SENDS THIS COPY TO DTSC WITHIN 30. DAYS.
<br />EPA 8700-22 To: P.O_ Box 3000, Sacramento, CA 95812
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<br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Pag-1 Information in the shaded areas
<br />is not required by Federal low.
<br />WASTE MANIFEST11.,9
<br />3. Generator's Name and Mailing Address A. State Manifest Document Number, �p
<br />2176
<br />6 �'
<br />Lawrence Livermore National Laboratory For the US DOE r
<br />7000 East Avenue, Livermore, CA 94550 ',B: StateGeneratar'sID
<br />4. Generator's Phone 1925 1422-1925 M. N. HAYES L-620 HIA ..Hof10
<br />5. Transporter 1 Company Nome 6. US EPA ID Number
<br />C. State T4nsporler s la (Reserv_ed:1. .
<br />Lawrence Livermore National Lab
<br />o. rrons crterslPhane
<br />P
<br />(925) 4221925
<br />7. Transporter 2 Company Nome B. US EPA ID Number
<br />E. State Tr6nsporter's ID. Reserved.J,
<br />F. Transporter'i Phone
<br />9. Designated Facility Name and Site Address 10. US EPA 10 Number _
<br />G:, State Facility's ID i
<br />LLNL, Site 300
<br />t•'
<br />H. FacilityrsPhone
<br />Corral Hollow Rd, P.O. Box 5505 L-620
<br />Tracy CA 95376 10 P
<br />(925) 4221925
<br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
<br />12. Containers
<br />13. Total
<br />Quantity
<br />14. Unit
<br />Wt/vol
<br />I. Wasre Number
<br />No.
<br />Tye
<br />a.
<br />State '
<br />Waste Articles explosives
<br />—
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<br />G
<br />, UN0471, PGI I (DbT—E 8451) (LAMI 4)
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<br />EPA/Other
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<br />N
<br />b
<br />Waste Articles explosive n,o.s.(PETN),1.4E
<br />Sr
<br />`52
<br />E
<br />UN0471, PGI I (DbT—E 8451) (LRG#114)
<br />00 1
<br />C
<br />007
<br />P
<br />EPA/Other
<br />R
<br />D003
<br />A
<br />T
<br />Wa%te Articles explosive, n. o, s, (PETN, RDX)
<br />51a352
<br />0
<br />, 1.4E, UN0471, PbII (DOT—E 8451! (ERG#114)
<br />r,�lea(,3
<br />CW
<br />022
<br />P
<br />EPA/Oiher
<br />R
<br />D003
<br />Waste Articles explosive n. o. s. (RDX), 1.4E
<br />Was
<br />UN0471, PGI I (DbT—E 8451) (bRG#114)
<br />St ate
<br />35.
<br />'EPA/blher
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<br />003
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<br />J. Additional Descriptions for (its listed Above
<br />K; Handling Cpdes.for Wastes
<br />listed Above
<br />A. 1176894, 076898, 076899, B.976897, C.0.76887, 976888,`
<br />a.
<br />b.
<br />(276889, D. 076890,- 076891, 076892
<br />15. Special Handling Instructions and Additional InformationEaergency Contact (925) 447-6880
<br />Wear protective clothing while handling. These eaterials are NOT radioactively contaeinated.
<br />Reference Release Number NA an the invoice.
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed,
<br />marked, and lobeW, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.
<br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically
<br />practicable and thar-1 have selected the practicable method of treatment, storage, or d' osa currently available to me which minimizes the present and future threat to human health
<br />and the environment; OR; if I am a small quantity generator, I have made a good t eft to minimize my waste generation and select the best waste management method that is
<br />available to me and that I can afford.
<br />JOSEX G me BYRNE
<br />Sig"
<br />Manch Day Year
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<br />17. Transporter 1 Acknowfed ement of Receiot of Materials
<br />R
<br />Printed/Typed Name
<br />Month Day Year
<br />a
<br />1 8-T—sporter 2 Acknowled ement of Receipt of Materials
<br />1
<br />Printed/Typed Nome
<br />Signature
<br />M onth Day Year
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<br />R
<br />'
<br />19. Discrepancy Indication Space
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<br />I
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<br />1
<br />20. Foci Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19.
<br />T
<br />Printed Typed Name
<br />Signature
<br />Month Day Year
<br />Y
<br />DO NOT WRITE E� THIS LINE.
<br />DTSC 8022A (1/99( While: TSDF SENDS THIS COPY TO DTSC WITHIN 30. DAYS.
<br />EPA 8700-22 To: P.O_ Box 3000, Sacramento, CA 95812
<br />y
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