Laserfiche WebLink
H135771 <br /> LAWRENCE LIVERMOr E NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION ❑ HWM Use Only Page 1 of <br /> 1.Building No: 2. Room No: 3. RMMA: 10.Hazardous OuMrContainer/Retention rank ID: Overpack? Scheduled Waste R� Void Requisition: <br /> y-� ) Pro rhes:-->>L��G. ❑ Yes No � ❑v"" ❑wo ❑DnTE:__J_J <br /> q,yypq�Nn Toxic <br /> (TJJ(3 5. kplac d e' 6.Account No: 12.Outer Container 13.Outer Container Size: ❑HWM Waste Run InKials/Da <br /> /7 1 . - 7 I ❑Corrosive Type: ❑ 1 gal ❑330 gal <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? o ❑Ignitable ❑Box ❑ 5 gal ❑660 gal ❑ -Site to LLNL RTO <br /> ❑Reactive ❑Can ❑ 7 gal ❑750 gal l?" <br /> ❑Yes, Activity Codes(enter up to four): W W W W ❑30 gal ❑1000 gal Commercial Shipment WTO <br /> 11.Waste Form: ❑Carboy ❑5000 al <br /> Comments: El 55 gal 9 ❑Secured Pickup <br /> Solid El Drum ❑85 gal ❑1x1x1.5 ft <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes No ❑Liquid Tank-Fixed ❑2x4x7 ft ❑ HWM Field Pump Out <br /> 8.Profile No: ED Tank-Portable ❑4x4x7 ft <br /> 9.Directorate: ❑Sludge <br /> H P ❑HWM Generated Waste <br /> ---- ❑Gas Other. Other: tal <br /> 7~— ❑cu ft 113 Sewer: DATE: /_/ RSDR#: <br /> 14.ITEM 15.AQUEOUS OkY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION t 9.QUANTITY <br /> NO. H NormalitySAMPLE NO. CODE <br /> r Item <br /> Amount un s <br /> �+ fAA00 4ML <br /> �Com;TA PX 18 3 q Diu <br /> For RMMA Waste *Normality Required if pH s 2 or pH z 12.5 USE CONTIN TION"FORM FOR ADDITIONAL ITEMS <br /> 20.Was the waste kept isolated from <br /> any operation that could have 22.Describe other controls used to prevent radioactive contamination: <br /> produced radioactive contamination 23-1 certify,to the best of my knowledge,that the information provided on this requisition is correct.I understand that I may be liable to State and Federal prosecution by intentionally <br /> (using a glove box,vent hood,etc.)? <br /> Yes El No Elproviding false information. <br /> (If no,full rad analysis required) Generator Name(Print-Last,First): L-Code: Ext.: Inspected by HWM Print Name-Last,First): Ext.: <br /> 21.Was the waste exposed to particleP�i� <br /> beams capable of inducitlrg radioactivity Signature: Employee No.: Date: gnat e: <br /> by activation? Yes Employee No.: Date: <br /> [--] No❑ <br /> (If yes,full rad analysis required) 37361 /5 7 <br /> ITEM RCRCH P Origin Form EPA NO. DTSC NO. MSDS NO. Hazardou Properties Handling Code: By: <br /> Prefix Code Code <br /> T C <br /> ❑ ❑I R <br /> Al— Date: Loc: <br /> v �� ❑ <br /> ❑ ❑ ❑ ❑ Chemical Compatibility Code: <br /> ❑ ❑ ❑ ❑ Department Generatin Waste: <br /> ❑ ❑ ❑ ❑ HWM Requisition provai:(S' na re) <br /> ❑ ❑ �, Ern plo No.: Date: <br /> 2_ 792-D, <br /> LL 5344-B(Rev.3/93) 7600-70302 <br /> White—HWM Copy <br />