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=:ate ct Coliformo—Environmental Protection Agency • <br /> arm acc_ c6-044 +u <br /> _ o.2050-,W39(Expires 9.30-94) See Instructions on back oflee 6. C', <br /> �'�ase cant or rvpe. hcrm desronea for use on elite 1? itch ' an eM of Toxic Substances Conti <br /> ( 7 )lypewrner. Sacramento,California <br /> 1. Generotor's US EPA ID No. Manifest Document No. i 2. Page I Information in the shaded areas <br /> � UNIFORM HAZARDOUS <br /> WASTE MANIFEST I is not required by Federal law. <br /> CA 21 Of 9 A— 9 0 0 0 2 9 4 2 3 8 of t <br /> 3. Generator's Name and Mailing Address <br /> Lawrence Livermore National Laboratory, Site 300 <br /> 7000 East Avenue, Livermore, CA 94530 <br /> in 4. Generator's Phone (510) 422_1925 Attn:A. Witt <br /> col L-820 <br /> Oi 5. Transporter I Ccmoony Name 6. US EPA ID Number <br /> ^i <br /> Erickson, Inc <br /> C A 0 0 019 4 618 31912 <br /> Transporter 2 Ccmoony Name 8. US EPA ID Number <br /> QI <br /> :J I <br /> Z 9. Designated Facility Name and Site Address 11 <br /> 10. US EPA ID Number <br /> ERICKSON INC. <br /> i 255 Parr Blvd., Richmond, CA 94841 -* <br /> dU i CA00109486i382 <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> 00=1 No. Type Ouantrty Wt/Vol <br /> 3 Non RCRA Hazaroous Waste,Solid (Empty Containers Last Containing <br /> C'4 <br /> E Diesel Fuel) associated piping) 1010, 1 TP 1012 10 0 I P <br /> l N �. <br /> xl E <br /> 7 R <br /> of T C <br /> O <br /> cl <br /> R <br /> LU <br /> Z <br /> UI <br /> z� <br /> O '` fiotu`for• :- <br /> a <br /> Q I {1 <br /> O I 15. Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT: (510) 447-6880 <br /> Z: Wear protective clothing Mile handling These materials are NOT radioactively contaminated. <br /> HWM Requisition Number H135774 TANK $7101Ui1 <br /> r <br /> J; 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q I packed,marked,and labeled,and are in all res m proper condition for transport b highway <br /> U I respects P P p y g aY according to applicable federal,state and international lows. <br /> I t <br /> J i i 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 tfie present and future <br /> V) threat to human health and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> Q Printed/Typed Name Signature '7%`�/[.��� O nth� ay� Year. <br /> y. Riohntt!8 Lodon on bohalf of LLNL <br /> U 1 r'01 <br /> Z T 17. Trans orter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> o <br /> N Printed/Typed N e SignatureMonth Day Year <br /> LLJ <br /> W a 18. Transporter 2 Acknow dement of Receipt of Materials <br /> LL r Printed/Typed Nome Signature <br /> E <br /> I Month Day Year <br /> O <br /> I <br /> LU 19. Discrepancy Indication Space <br /> Q F <br /> I cility Owner or Ooerator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Yi ZE�lnrated/Typed Name Sig re Month Day Year <br /> Yip 171 � q <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> EPA 87 <br /> DTSC 706-0022(7/92) (Generators who submit hazardous waste for transport ouf-of•state, <br /> — produce completed copy of this copy and send to DTSC within 30 days.) <br />