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Sample Transportation Determination <br />Section I <br />Requester Doug Villela Phone # 2-0927 <br />Requisition # / Sample B875 -CW <br />Waste Type: Non -hazardous waste or retention tank (not DOT) — Print and <br />sign below and process sample. No further action required. <br />❑ Hazardous ❑ Radioactive ❑ Mixed ❑ CA Combined <br />Number of containers: <br />40 mL <br />125 mL <br />250 M1= <br />500 mL= 2 Amber <br />1000 mL <br />Print, and sign below and forward to Sample Team Lead for further review and <br />Section II completion. Ensure WDR or other preliminary characterization <br />information is submitted along with this form. <br />Determined bar (Print) Doug, Villela Date 8/25/08 <br />Signatu <br />Section II (Sample Team Lead — complete and return to Requester if not DOT <br />regulated) <br />DOT Regulated? ❑ Yes ❑ No <br />Determined by (Print) <br />Signature <br />Date <br />If DOT regulated forward to RHWM Disposal Office for completion of Section III. <br />Section III <br />DOT Information <br />Proper Shipping Name <br />Packaging <br />❑ Rad Info. Attached <br />COC.# / 7 '� 4d <br />WGS 0140, Expiration Date: 07/31/11 <br />