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<br />ifornfa-Environmental Protection Agency
<br />sved OMB No. 2050-0039 (Expires 9.30=991
<br />SCB. In51�UCt10�5 On back of page b
<br />i or tyA- Form designed for use on efit.&t 12 -pitch) typewriter.
<br />I G t US EPA 10 No - Manifest Document No.
<br />enera or s
<br />UNIFORM HAZARDOUS'
<br />WASTE MANIFEST
<br />3. Generator's Name and Mailing Address
<br />Lawrence Livermore National Laboratory For the US DOE
<br />7000 East Avenue, Livermore, CA.94550
<br />A. Generators Phone 1 925) 422-1925 MIN HAYES f -620
<br />S. Transporter I Company Name 6, US•EPA ID Number
<br />Lawrence Livermore National Lab 4=k=I9
<br />7. Transporter 2 Company Name 8. US EPA ID
<br />9. Designated Facility Name and Site Address 10. US EPA ID Number
<br />LLNL, Site 300
<br />Corral Hollow Rd, P.O. Box 5505 L-520
<br />Tralcv CA 95376 r_P1?-090
<br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number(
<br />, LlN0471, P61I (DbTeE 8451) LLRI341lfi) (HMiA), 1.4E
<br />In.
<br />Waste Articles. explosive n. o. s. (PET�1), 1.4E
<br />,UN0471,PGII(DOT-E 8451)(RG#114)
<br />tJa`ste Articles expplosive, n. o. s. (PSTN, RDX)
<br />,1.4E,UN0471,PuII(DOT-E 8451)(ERG�114)
<br />I Waste Articles explosiven. o. s. (RIM, 1.4E
<br />i,UN0471,PGII(DbT-E 8451)(RG#114)
<br />12.
<br />No.
<br />Department of Toxic Substances Control
<br />Sacramento; California
<br />2. Page I Information in the shaded areas
<br />is not required by Federal law.
<br />I of 0
<br />A: State:MdmFest Document Number n
<br />2 76.64.;?
<br />B'S SfafeGeiierato?: s
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<br />C $tate Transaorter s ID (Rase d.I
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<br />'F irpnsporter s phone,
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<br />G State Fatality s ID .'
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<br />H Pacilttys Phone
<br />19 53
<br />s
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<br />iainers
<br />13. Total
<br />Id. Unit
<br />Type
<br />Ouantity
<br />WI/Val
<br />I:.`,`�as e'Number w„ -,_t„
<br />Ki Haridling.Codes for,Wai4iViled Ano-
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<br />bove s.
<br />=J^ Additional-D'esciiptions:faa'Mdterinls Ltsteo A c s, f b, i
<br />4='76894` `''=7,6898,. X75899, B .i17�3��, 28
<br />_.
<br />-176I B'89-.'
<br />15. Special Hondling Instructions and Additional. lnformationEBerg ency Contact . (925) 447-6860
<br />kai' pntective clathiq while ITandiing. These 9aterial5 arc. NGT radicEtiyel J coilta3111at2d.
<br />Reference Release Number NA on the invoice,
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the coolants of this consignment are fully and accurately a--- bedabove by proper shipping name and ore classified, packed,
<br />mocked, and labeled; and are in all respects in proper condition far transport by highway according to applicable international and national governmenl regulations: ' t
<br />If I am a large quantity generator, I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree 1 have determined l0 to economically
<br />practicable and that l have selected IFe practicable method of treatment, storage, or di osol'currently available to me which minimizes the present and future threat to human health..
<br />and the environment; OR, if k am a small quantity generator, I have made a good
<br />off 'to minimize my, waste generation and -select. the best waste management method that is
<br />available to me and that I can afford. �!
<br />F
<br />Sign tur Month Day Year.
<br />Printed/Typed Name s�
<br />JOSEPH G. BYRNE /
<br />17. Tranb orter 1 Acknowleciciement of Receipt of Materials ` Month Day Yeor
<br />Printed/Typed Name .-� V natural`
<br />I ansporter 2 Acknowled'aement of Receipt of
<br />srinted/Typed Name
<br />19. Discrepancy Indication Space
<br />;l
<br />• ;L
<br />I 20. Facility Owner or O e
<br />(j Printed/Typed Name
<br />IY.
<br />L
<br />DTSC 8022A JI/99)
<br />EPAI 8700-22
<br />I
<br />I
<br />alerials
<br />Signature Month Day I Year
<br />Signature
<br />DO NOT WRITE BELOW THIS LINE
<br />in Item 19'.
<br />Month Day Year
<br />Blue: GENERATOR SENDS -THIS COPY TO DTSC WITHIN 30 DAYS.
<br />To: P.O. Box 400', Socromento, CA' . 95812-0400
<br />P
<br />;EPA/Oche•.::.,
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<br />Ki Haridling.Codes for,Wai4iViled Ano-
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<br />=J^ Additional-D'esciiptions:faa'Mdterinls Ltsteo A c s, f b, i
<br />4='76894` `''=7,6898,. X75899, B .i17�3��, 28
<br />_.
<br />-176I B'89-.'
<br />15. Special Hondling Instructions and Additional. lnformationEBerg ency Contact . (925) 447-6860
<br />kai' pntective clathiq while ITandiing. These 9aterial5 arc. NGT radicEtiyel J coilta3111at2d.
<br />Reference Release Number NA on the invoice,
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the coolants of this consignment are fully and accurately a--- bedabove by proper shipping name and ore classified, packed,
<br />mocked, and labeled; and are in all respects in proper condition far transport by highway according to applicable international and national governmenl regulations: ' t
<br />If I am a large quantity generator, I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree 1 have determined l0 to economically
<br />practicable and that l have selected IFe practicable method of treatment, storage, or di osol'currently available to me which minimizes the present and future threat to human health..
<br />and the environment; OR, if k am a small quantity generator, I have made a good
<br />off 'to minimize my, waste generation and -select. the best waste management method that is
<br />available to me and that I can afford. �!
<br />F
<br />Sign tur Month Day Year.
<br />Printed/Typed Name s�
<br />JOSEPH G. BYRNE /
<br />17. Tranb orter 1 Acknowleciciement of Receipt of Materials ` Month Day Yeor
<br />Printed/Typed Name .-� V natural`
<br />I ansporter 2 Acknowled'aement of Receipt of
<br />srinted/Typed Name
<br />19. Discrepancy Indication Space
<br />;l
<br />• ;L
<br />I 20. Facility Owner or O e
<br />(j Printed/Typed Name
<br />IY.
<br />L
<br />DTSC 8022A JI/99)
<br />EPAI 8700-22
<br />I
<br />I
<br />alerials
<br />Signature Month Day I Year
<br />Signature
<br />DO NOT WRITE BELOW THIS LINE
<br />in Item 19'.
<br />Month Day Year
<br />Blue: GENERATOR SENDS -THIS COPY TO DTSC WITHIN 30 DAYS.
<br />To: P.O. Box 400', Socromento, CA' . 95812-0400
<br />
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