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Syme of California—Environmental Protechon Agency <br /> =arm Approved OM ev 6-0pi <br /> (039 Ex res 9-30.941 See Instructions on back ofe 6. ��• <br /> -"ease onnt or type. Form designed for use on elite f12-pitchl r,ter. Department of Toxic Substances Connc <br /> Sacramento,California <br /> UNIFORM HAZARDOUS Generators US EPA ID No. Manifest Gocument No. 2. Page 1 Worrttanon in the shaded areas <br /> WASTE MANIFEST C Al2 g 9 0 019 0 !0 0 ;2 9 1 4 12 2 4 of is not required by Federal law. <br /> 3. Generator's Nome and Mailing Address <br /> 01 <br /> LinLawrence Livermore National Laboratory, Site 300 <br /> PO Box 808, L-820, Livermore, CA 94551 <br /> in 1 [4. Generator's Phone (510) 422-1925 Attn:Arlene Wilt L-820 <br /> �I <br /> 0' 5. Transporter I Company Name b. US EPA ID Number - <br /> Evergreen Environmental Services <br /> �i 'CIA D1918101819 517j8j1 R� <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> I <br /> Q <br /> Z I 9. Designated Facility Nome and Site Address 10. US EPA ID Number <br /> 0: tver9reerl 09,Inc , <br /> 01 6880 Smith Avenue <br /> LL! NeWBrK.CA 94560 <br /> H:_f-anlitX's Phone <br /> I. <br /> ui CAD 9! 810 8 !8 7 411 j8 <br /> Z 1 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 1 12. Containers 13. Total 14. Unit <br /> H I a No. T e Quantity Wt/Vol ; <br /> V 3 CORlbusbble Liquid n.0 S., NA 1993, Ili <br /> o G I (diesel tuel) <br /> E I O GG <br /> 0 0, 1 T T <br /> N1 DI �I� <br /> col N I <br /> 00! E <br /> R <br /> of A I I <br /> oI T C. <br /> C?I0I <br /> Yi R <br /> i <br /> uUjI <br /> Z S s i!i!`ttiorw` }tons or - <br /> ak sA '� Hdi arm' d Tor astei'" <br /> a _ <br /> to - <br /> Lu N 01 <br /> Z <br /> 15. Special Handling Instructions and Additional Information <br /> Wear Protective Clothing When Handling. EMERGENCY CONTACT.- M.N. Hayes, )510 447-8880 <br /> z LLNL ShipDoc Number. <br /> w These materials are NOT radioactively contaminated. <br /> 16 GENERATORS CERTIFICATION. I hereby declare that the contents of the consignment are fully and accurately described above b proper shi in n <br /> Q packed,marked,and labeled and are i Y P P pp g name and are classified, <br /> n all respects in proper condition for transport by highway according to applicable federal,state and international lows. <br /> U <br /> If 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 have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> a threat to human health and the environmentORif I all quantity N ; , m a small <br /> q ty generator, I have made a good faith effort to minimize my waste generation and select the best <br /> cc waste mono ement method that is available to me and that I can afford. <br /> Q Printed/Typed Nome Signature v` hponth Day Year <br /> ,. Richard B. Loden on behalf of LLNL O , � f 9, u <br /> U <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of MaterialsLu <br /> 7 <br /> R <br /> w Printed/Typed Nome Sinater <br /> Ws ✓ f2 f Month Day Xpar <br /> Ns _ <br /> v �— .. C, <br /> LU a 18 . Trans iter 2 Acknowled ement of Recei t of Materials <br /> T Printed/Typed Name <br /> U- Signature <br /> E Month Day Year <br /> O R <br /> I <br /> w 19. Discrepancy Indication Space <br /> V) <br /> QF <br /> UA li <br /> -) L <br /> f 20. Facility Owner or O erator Certification of recei t of hazardous materials covered 7thismfestexce t as oted in Item 19. <br /> T Printe Ty NameSignaturetY � Month Day Year <br /> 71 1 <br /> DO NOT WRITE THIS ,(INE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DISC 60222 (7/92) <br /> EPA 8700-22 (Generators who submit hazardous waste for transport ovtof-state, <br /> produce completed ceps• c! this copy and send to DTSC within 30 days.) <br />