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• State o) Cclifornio—Environmental Protection Agency <br />Fr.rm Approved OAB No. 2050-0039 (Expires 9.30.991 See Instructions on back of poy,- 6. Deportment of Toxic Substances Control <br />Please print or type. Form designed /or use on elite () 2 -pitch) typewriter. Sacramento, California <br />LL <br />IU <br />Ce <br />W <br />1— <br />Z <br />W <br />V <br />W <br />N <br />Z <br />O <br />ri <br />N <br />W <br />Q <br />Z <br />O <br />Q <br />Z <br />W <br />Q <br />a. <br />V <br />J <br />V) <br />O <br />} <br />V <br />Z <br />W <br />U <br />04 <br />W <br />LL <br />O <br />h <br />Q <br />V <br />12 <br />Is <br />1 Generator's US EPA ID No. Manifest Document <br />UNIFORM HAZARDOUS <br />No. 2. Page I Information in Ike shoded areas <br />is not required by Federal low <br />WASTE MANIFEST <br />A Iny�I�/ <br />3. Generator's Name and Mailing Address V I I bud V 64 v VA. <br />Sl a Manifest Document Number <br />Lawrence Livermore National Laboratory She 300 <br />23440668 <br />P.O. Box 808 L-786 <br />B. Stole Generalor's ID <br />4.W Amm k A 1345511 <br />F 0 <br />hipping—g9A—A72-1 92 <br />III I <br />5. Transporter 1 Company Name 6. US EPA ID Num or <br />C. Stale Tronsperler's ID (Reserved.1 <br />Safety Kleen Systems Inc T X R a 0 005 c4) 30 <br />h <br />D. Tronsporter_yhve �` 57 0 19411 7 <br />7 Transporter 2 Company Name 8. US EPA <br />E. Stole Tronsporler's ID IReserved.1 <br />F. Tronsporter's Phone <br />9 si nae Facility,Nome and Site Address 10. US EPA ID Number <br />Sa�e�y �C�een ystems, Inc <br />G. Stale Fociliy's ID <br />400 Market Street <br />H. Facility's Phone <br />Oaidand CA 94807 <br />11. US DOT Description (including Proper Shipping Nome, Haxord Class, and ID Numberl 2.Containers <br />No <br />13, Total Unit <br />W. Type Quantity WI/Vol 1. Waste Number <br />a.Stole <br />s s <br />1� <br />GEPA/Other <br />E <br />Nliquid <br />(elhejr�ileled r <br />Stole <br />E <br />R <br />EPA/Other <br />A <br />T <br />c. <br />Ll <br />sem. <br />O <br />R <br />- .. M <br />s -I <br />EPA/Other <br />d. otJ-rZ,ttZ^ uAZA(Z-Dcv5 I'JkjTE Ln -114110 erNOXyIaT>+D <br />stole <br />4licdHoLS)TMjM6rjJ1j rG It)MPC- <br />0 O '7 <br />iii <br />e D134 <br />1 � <br />G <br />EPA/Other <br />J. Additional Descriptions for Materials Lisled Above <br />K. Handling Codes for Wastes Listed Above <br />a, b. <br />si. t <br />291 P. <br />c. � <br />d. <br />15. Special Handling Instructions and Additional Information <br />T,T, ship doc# u-59166, Lum load 0 sx05-01. Wear protective clothee while handling, Theee <br />materials are not radioactively contaminate rAFST RST 3i I o T -111 1111,7- (a -1 k VG 1 Emergency contact; <br />FM6RCtENL`j RESP 6C)04(00I160(-z1 V;K tf- UND6L%4eRA13IF RETUklJ7046NcAATCtQ925-447-6889 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the conlents of III is consignment are fully and accurately described above Is proper shipping name and ore classified, packed, <br />marked, and labeled, and are in all respects in proper condition (or transport by highway according to applicable inlernalional and nalionol government regulations. <br />11 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 hove determined to be economicallyy <br />practicoble and that I have selected the practicable method of Treatment, storage, or disposal currently available to me which minimizes the present and future threat to human heohh <br />and the environment; OR, if I am a small quontity generator, I have made u y ilk effort to minimize my waste generation and select the best waste management method ti+ol is <br />to that I <br />available me and con afford. <br />Printed/Typed Nome <br />Sir, lu <br />Month Day Year <br />'1) � 015- <br />eupb r,, Byrne on be <br />_ <br />1 <br />_ <br />17. Transporter 1 Acknowledgemtnt of Receipt of Maleriols <br />17. <br />S <br />Printed/Type N �� i oar r Month Day Yeor <br />o �_, . - 1 I/ 10 s I <br />P <br />0 <br />_---- <br />18. Transporter 2 Acknowledclisment of Receipt of Materials <br />_I <br />Printed/Typed Nome <br />Signature <br />Month Day Year <br />E <br />19, Discrepancy Indication Space <br />A <br />RE 3c c T-- 0A ��� `tom Cu sT�•��z <br />C <br />I <br />1 <br />_ _ _ <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19 ------Month <br />T <br />Y <br />Printed/Typed Nome <br />Signature <br />Month Do <br />I ' <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) While: TSDF SENDS THIS COPY TO DISC W`IHIN ,lis 0-\`$ <br />EPA 87022A To' P 0 Box 3000, Sucrrsnsuntn CA t. 81 <br />