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H135774 <br /> LAWRLNCE LIVERMUhr- NATIONAL LABOHA I OHY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION I-J <br /> Hoylnn �, 3 HMrSA 10 flat:cities Outer Container/Retention Tank ID: Overpeck7 scneawuu w•ue awn o.1). Void Requisition: <br /> /1 a[ fns I 1 rJr I'ru�erhes (]r.• [7ro <br /> -I . r `_ �, � <br /> ..�- - DATE:J Accuunl Nu; t2 Uu� rr,. Ve i: n HWM Waste Run Initials/Date e l7? t f CuI yl„' <br /> , <br /> I'/dl I 1330q.11 RTO <br /> V1,tsL„rvinnnuzalwn Lffurls Practiced During Generation ill this W:isle' rt,. 7 [ 1 Hua I I ', !1,11 1660 gal [ 113f ile to LLNL <br /> u ` I I 7 l ll 11 751) all eco <br /> I Iwc �. 1 Can 3 11 1000 J Commercial Shipment <br /> r es Activity Codes(enter up to four). W W W W [ <br /> ,.nur.wds _ I 1 Waste Form ( I Carboy I 130 ya1 galWTO � <br /> [ 1 sal L. s5 gal 1 15000 gal F)Secured Pickup <br /> ----------------- ----------- -- - I Dfum []85 gal I I1xix1 5 It <br /> l i,.l nu,Waste Munnuzation effort begin in current calendar year? L]Yes L'a" LiyuiJ jank-Fixed I 12x4x 7 it n HWM Field Pump Out <br /> 8 Profile f4a. [� y L]Tank-Portable [ 14x4x7 It ❑ <br /> 9.Dneaorate � �� I ]Sludge <br /> jyal HWM Generated Waste <br /> _H-.- P_---- I I Gas Darer Oti,er�''�"" j] <br /> ---- _ <br /> Sewer:_-- DATE:-_—�- --RSDR rY: <br /> 14 ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19 QUANTITY <br /> NO. Itl NormallySAMPLE NO. CODE <br /> _ <br /> a <br /> Fo,g-Loeb►�Ajo1< th6- a <br /> COMP ET <br /> - -- <br /> -- --------- - - - - <br /> BY <br /> For RMMA Waste •Normalily Required if pH 2 or pi I I <br /> ------ ----- <br /> ?U Was tl/Bc i ON 11M/4 fl;_b%itjHAt Jr7.4i>(nl,,Uv4t :;:Lia <br /> he waste kept Isolated from -- -- -- - <br /> any(,purmun that could have 22.Describe other Controls used 11)prevent lddioac;trve cuntainin,dlon <br /> pr.>iluced radioactive contamination 23.1 certify.to the best of my knowledge,that the uduunalrun provided on this requisition rs cwe,I 1 understand 111.11 1 nidi be hdldu to%I-ile and I.d,Aol lay e.ul,,.n Lr uucuh.u.,,y <br /> nrsmg a glove box,vent hood,etc.)? providing false Information. y <br /> Yes❑ No❑ <br /> 111 rur full rad analysis required) Ge for Name(Pri t-Last.First -- - - - <br /> � ) L-Cade Ext Inspected by HWM Prim Name-Last•First) Exl <br /> �E1 R� .S�A�JI€ 49 I <br /> ere waste exposed to particle Y -- <br /> n of wducllry iacfioaclivily / ���/ <br /> it Snyl.diur Employe,N,� I4t, Signature: En pwyce rJu Date <br /> i It .., Iuh ra,i,d,aP7sls reywredl --- _ �•'�I��3C) �/ !S� 77,��L- I< �j <br /> ITEM RCH RCH P Ori In Form EPA NQ Handling Code: g <br /> Prefix Code Code DTSC NO. MSDS NO Hazardous Properties y <br /> T C I f1 <br /> Date: Loc: <br /> Chemical Compahbndy Cude: <br /> ------- ----- --- ---- --...- ------- --- ----- ------------ I �'/ 7/�til <br /> Department Genera r9 Waste 9 <br /> -- --- F 1 f-A 1- 1 I I <br /> HWM Requisiti Approval(St rature) <br /> ❑ r—� r—� Empl No.: Data: <br /> 761 --- 7 <br /> 11 b344 R(Rev 3;93) 760070302 <br /> White-HWM Copy <br />