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Please print or y d " or use <br /> y-elite( S@@ IRSYrueYi®Rs OR back Of page 6. <br /> type. Form designed for use on elite(12pitdt)typewriter. /7 C <br /> %����J Department of Toxic Substances <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. 7 J ��a.California <br /> Manifest 0 t No. 2. Page I Information in the shaded areas <br /> WASTE MANIFEST a is not required by Federal law. <br /> 3. Generator's Name and Mailing Address of 1 <br /> Lawrence Livermore National Laboratory. Site 300f Dxncument <br /> For the U.S.Dept of Energy <br /> 7000 East Avenue. Livermore.CA 94550 <br /> N 4. Generator's Phone Ba':StatePGe>aratpr lD "�"�'? <br /> �' (510 > 422-1925 <br /> 0° Attn: A. Witt L-620 Ff <br /> p 5. Transporter 1 Company Name t t <br /> t <br /> O 0. US EPA ID Number <br /> � �� tm1''-`38n�Ose G y ` �;strsr�rrarapar►ers Ity �"�"; �•� <br /> f� <br /> � o(Z oil t D.�"�eatlsportar.'s Phatro , <br /> 7. Transporter 2 Company Name <br /> f Q 8. US EPA ID Number <br /> U E:;Statei Transporters lD:` <br /> t - •- "a"sm� x <br /> LO Q 9. Designated Facility Name and Site Address F,eT'an�rter'S Phone yx <br /> r C) 10. US EPA ID Number G s F«iIr s IDdo ERICKSON INC. <br /> rs r <br /> QUO <br /> Oo Ll- 255 Parr Blvd., Richmond, CA 94801 <br /> Hr'Fa� r� CADO 0 9418 <br /> 8 3 I x . 810 r'` <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> 12. Containers 13. Total 14. Unit <br /> a' No. I T Quantity wt/vol <br /> y Non RCRA Hazardous Waste Solid <br /> M E (residue last contained oil& water)(with associatedI I pn9) <br /> 65 N b. Pa � TP 0500 P <br /> 00 E <br /> C14 R - <br /> V <br /> A <br /> o T C. <br /> Ce R, <br /> W <br /> Z d. <br /> W <br /> L <br /> W <br /> V) <br /> O <br /> Uj <br /> 5 ff <br /> .JCX <br /> illJilliiii!lll 'ars:aaE •�4 f.'.Yf�.,� <br /> ll;lli <br /> Q 15. Special Handling instructions and Additional Information e 'u <br /> Q EMERGENCY CONTACT: (510)447-6880 IT Job#762668 <br /> Z UCLLNL Shipping Doc#8- <br /> --Z-e-0y/ <br /> Reference Release #IWY_L� <br /> Wear protective clothing while handling on the Invoice. <br /> 16. GENERATOR' These materials are NOT radioactively contaminated. <br /> Qr $ CERTIFICATION: I hereby declare that the contents of thisconsignment ore fully and accurately described above by proper shipping <br /> packed,marked,and labeled,and are in all res <br /> pec peen in proper condition for transport by highway according to applicable international and national governmentname and aregulation classified,re <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 /> 'J 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 environment;OR, if I am a small quantity <br /> N q ttty generator, I have made a good faith effort to minimize m waste <br /> waste management method that is available to me and that l can afford. <br /> g Y generation and select the best <br /> O Printed/Typed Name <br /> Signature <br /> V Riehared 8 laden on behalf of LLNL / , Month Day Year <br /> Z T 17. Trans orter 1 Acknowled ement of Receipt of Materials <br /> W A <br /> Ur t4 Print ed N nl <br /> �} Signa e <br /> W <br /> p C �'^ (/ Month Day Year <br /> 0 18. Trans orter 2 cknowled ement of Receipt of Materials / <br /> W t Printed/Typed Name ` <br /> u' E iSigna re <br /> � <br /> N x Month Day Year <br /> ii <br /> W � 19. DiscrepanDiscrepancyIndication Space <br /> UA <br /> Z C <br /> _ 1 <br /> L <br /> I20. Faciii Owner or Operator Certification of recei t of hazardous materials covered b <br /> T Printed/Typed Name this manifest except as noted in Item 19. <br /> Y Sig <br /> Month <br /> Day Year <br /> '1 <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (9/93) `-a0o-n TSDF SENDS THIS COPY T GENERATOR WITHIN 30 DAYS. <br /> EPA 8700-22 :Generators who submit hazardous waste for transport out-of-state, <br /> produce completed copy of this copy ann send to DTSC ..;shin 30 days.) <br /> ob — — - <br />