Laserfiche WebLink
Please print or tfpe. (Form designed for use on elite (12 -pitch) typewriter.) <br />Form Approved. OMS No. 2050-0039. <br />Style CF 18 LA8F1]"t .sTFA0 f80o)621-5808 » .w)eimastercorn EPAForm 8700-22A (Re. AT�Ii <br />r ='' F i <br />ORIGINAL -RETURN TO GENER <br />UNIFORM HAZARDOUS 21. Generator's US EPA ID No. Manifest Document Na <br />22. Page Information in the shaded <br />WASTE MANIFEST <br />areas is not required by Federal <br />(Continuation Sheet) <br />law. <br />L, State Manifest Document Number' <br />;i <br />23. Generator's Name <br />Lawrence Livermore National Laboratory For the US DOE <br />21.766492 <br />:M.SateGenerator's ID <br />7000 East Avenue, Livermore, CA 94550 <br />A HC2 36-04.03ES <br />24. Transporter Company Name 25, US EPA ID Number <br />?N': State Transporter's ID' <br />O, T;ransporter's Phone <br />26. Transporter Company Name 27. US EPA ID Number <br />P. St'ateTransporter's ID <br />a. T,ransperter's Phone <br />` <br />28. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />29. Containers, <br />Total <br />77- <br />Unit <br />Wt it <br />Waste No. <br />H1A <br />No. Type <br />Quantity <br />ol <br />I <br />a. <br />X <br />Waste Articles, explosive, <br />356 ' <br />J <br />n, o. s. (triaminotrinitrobenzol), 1.4E,UN0471 <br />00Z3CW00 <br />E!5P <br />,PGII(DOT—E 8451)(ERG#114) <br />D003 <br />b. <br />I <br />c. <br />c <br />d <br />I <br />E <br />N <br />E <br />R <br />A <br />e. <br />T <br />0 <br />R <br />f. <br />•I <br />I <br />9• <br />h. <br />'S. Additional Descriptions for Materials Listed, Above <br />T_Fiandling Codes for Wastes Listed Above <br />..:.A.076893, Q76896, Q76895 <br />I <br />32. gg❑❑ecial Ha ,lin n iiructi and Additional Information Et C44tact (925) 447-6888 <br />fl�ar protec ive��oi�hing rti�ie handling, hese saterials are�atlioactively contaiinated. <br />Reference Release Number NA on the invoice. <br />T <br />33. Transporter _ Acknowledgement of Receipt of Materials <br />Date <br />Year <br />A <br />Printed/Typed Name Signature <br />Month Day <br />N <br />S <br />0 <br />34. Transporter Acknowledgement of Receipt of Materials <br />Date <br />R <br />Printed/Typed Name Signature <br />onth Day Year <br />E <br />R <br />A <br />35. Discrepancy Indication Space <br />C <br />i <br />T <br />Y <br />„n.�lPiP <br />Style CF 18 LA8F1]"t .sTFA0 f80o)621-5808 » .w)eimastercorn EPAForm 8700-22A (Re. AT�Ii <br />r ='' F i <br />ORIGINAL -RETURN TO GENER <br />