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u fu::� <br /> of�CoLf�omyr�ibs.-'m-En <br /> tate vironmental Protection Agency <br /> onn oar—ea 8 No.2050-0039(Expires 9-30-94) • See Instructions on back of Ote 6, <br /> Please.pnnf,or type. Fo—designed for use on elite(12-pitch)typewriter. �� Department of Toxic Substances Contri <br /> Sacramento,California <br /> I i 1. Generators US EPA ID No. Manifest Document No. 2. Pae 1 Information in the shaded areas. <br /> UNIFORM HAZARDOUS g <br /> r <br /> WASTE MANIFESTS Q 01910101012 :9 4 2 2 2 of .1 is not required by Federal law. <br /> r :,3-,Ge nerator's Name and Moiling Address m <br /> L.iwrenoe Livermore National Laboratory; Site 300 <br /> PO Box 808, L-820;, fvetfiore.0.94551 . V: <br /> SiL tet, <br /> 4 Generators Phone (510) 422-1925 ' Attn:Arlene Witt, L-620 <br /> p 5. Tran'sporter`1 Company,Name 6. US EPA ID Number <br /> Evergreen Environmental Services <br /> ClAlD918101� a191517181 1 Tod~ ot; <br /> " .:Q 7. Transporter 2 Company Name 8. US EPA ID Number - �$tate�T ar r�,�D • ,� <br /> U ypy <br /> •;Q 7ransporter,¢`,PhotK± �r� � � t" <br /> EvDesignate facility Name and Site Address 10. US EPA ID Number s <br /> ergreen ,InC G Statou ify s lD } <br /> i.in Z err �"��'� <br /> �0 6880Smith Avenue <br /> PF <br /> Newark,CA 9456o <br /> �-a C A D 9 8 0 8 8 7 4 1 8 <br /> �.y� <br /> 00 Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> W Z a No. T a Quantity Wt/Vol m1;Wgsfe Numbed� `s <br /> N Combustible Liquid n.o.s.,NA1993, Ili 4 <br /> Cn 3 G _(dlesel AM) 097 <br /> Ci E O O 1 T T 0 Q Others ;x <br /> 00 N b. <br /> CO <br /> F <br /> o A <br /> O T C. <br /> 00 <br /> Z KPA r� <br /> >. <br /> d. <br /> WMR <br /> $tate <br /> �.ttii Ef AJ':j, 7 <br /> ZCL <br /> o ?� <br /> ' ar <br /> w <br /> F <br /> ..Q l>llr s+r a, � ¢.. �` av+� ax i"`�s t�{""• .• r �s.• A.. a� tx `��€ <br /> Q SpeciHandlingInst r ion pnd itional Information <br /> i= Near�rotec ve �l�Ing hen Handtmg. EMERGENCY CONTACT: M.N. Hayes, (510) 447-8880 `4 <br /> Z LLNL ShipDoc Number. S- WS? Reference Release Number 1WY-_mSA � on the invoice. <br /> = These materials are NOT radioactively contaminated. <br /> J 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and.are classified, <br /> Q packed,marked and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international.laws. <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 /> CL <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 /> N threat to human health and the environment;OR, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generafion and select the best <br /> waste management method that is available to me and that I can afford. <br /> Q Printed/Typed Name 101011gMonth Day Year . <br /> >- Richard B. Loden on behalf of LLNL <br /> .Z i 17. Transporter i Acknowledgement of Receipt of Materials <br /> A' Printed/Typed Name <br /> N <br /> W Y Signatur Day <br /> _ - •MonthYear <br /> � <br /> r (t✓ 2 a Q L <br /> V / <br /> W a 18. Trans orter 2 Acknowled Acknowledgement of Recei t of Materials <br /> W T Printed/Typed Nome Signature - <br /> E Month' Day Year <br /> O R <br /> W 19. Discrepancy Indication Space <br /> N <br /> Q F <br /> V A <br /> Z b $ ^C _ <br /> LG <br /> 1 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. �h �1 1w9kt <br /> T Printed/Typed Name Signature 4� <br /> 1r Month Day tsar <br /> rh <br /> y; <br /> DO NOT WRITE BELO LINE <br /> N r tt Ifi�,a " <br /> t <br /> t-f x Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 bA S <br /> DTSC'8022A (7/92) (GeneiVors who submit hazardous waste-.fot•tiara orf ou}-gf <br /> EPA 8700-22 �nt�� i � y yr43 Toduce completed copy of this co and send Jo DTA <br /> PY Cs ti c v. <br />