Laserfiche WebLink
Sample Transportation Determination <br />Section I lV' l f, yo No _P D VD <br />Requester DOUG VILLELA Phone # 2-0927 <br />Requisition # / Sample ID W311145 '). <br />Waste Type: ❑✓ Non -hazardous waste or retention tank (not DOT) — Print and <br />sign below and forward to CES with sample, No further action required. <br />❑ Hazardous ❑ Radioactive ❑ Mixed ❑ CA Combined <br />Number of containers: <br />40 mL <br />125 mL <br />250 mL <br />500 mL 1 <br />1000 mL 1 <br />Print and sign below and forward to RHWM Disposal Office for further review and <br />Section II completion. Ensure WDR or other preliminary characterization <br />information is submitted along with this form. <br />Determine r t) DOUG VILLELA Date 11/13/07 <br />Sign ure <br />Section II (RHWM Disposal Office — complete and return to Requester. Establish <br />a sampling/shipping date with Sampler and CES) <br />DOT Regulated? ❑ Yes ❑ No <br />Determined by (Print) <br />Signature <br />DOT Information <br />Proper Shipping Name <br />Packaging <br />❑ Rad Info. Attached <br />Section III (CES) <br />COC # I I I ) I <br />WGS 0140, Expiration Date: 08/04/09 <br />Date <br />