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State of California—health and Welfare Agency <br /> Form A rpv ;,OMB No,'20b0-0038(Ex res 8.30.91) Department of Health Services <br /> Rp p A: 1 xic substances Control Division <br /> Please pfint or type. (Form designed for use on*life(12-pitch typewriter). / Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page , information in the shaded areas <br /> WASTE MANIFEST 2 Is Ig 0 0 9 0 0 02 `am tgc7 of 1 'Is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. Stats Man kr•.};. <br /> Lavaeme Lhemuxle Nabomf Laboratory, She 390 -�^- <br /> P,O.SM 65W, L0, LM ifirvore. CA 94530 1e, st t e at is to <br /> 4. Generator's Phone( �, Gy i"?Whl <br /> ATTN: M.N. Hayes <br /> Qj 6. rangQoySrtgr 1 Com ny Name 8� A ® A umperQ ® 7 C. State Transporter's ID ' If <br /> u, J4F1 1 M I1 4 V <br /> l�T ti 5 D. ransport*r'e Phonei; <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> F. T(ansponoeq Phone <br /> cc °r r' <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> tR"WNPr>C. CA10110108486392 <br /> PARA BLVD, H. Facnity'a Pnone :•s4 <br /> NCHMOW,CA. 0-1111510 <br /> 12. Containers /3. Total 14. <br /> 11. U8 DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit "^'.Wasts No. <br /> p u No. Type Wt/Vol <br /> R <br /> Norl- <br /> 4y U a. H8Z YV�,f <br /> E <br /> m�' 001 T 16000P <br /> N CEfYIj/ I'1Br OOf"tiSff�Yl� I ILIS1� E �.: <br /> E b. Stpts" <br /> AA,--��' <br /> T, <br /> SRA/t�th.4t q <br /> d. <br /> $tato.;T;Sid i�•'t^. <br /> uj <br /> r <br /> EPA*Qtna,�, <br /> J. ALPAW&MONYAO Ia Llated Above ,, .•,r;; r . p. :~s. ,b:) ,; i rr .( K..Handling Codas for lyFailed Abovq <br /> �. a• + mb n <br /> c. <br /> uj <br /> _ . _ Elf., <br /> •. <br /> 18. Special Handling instructions and Additional Information <br /> In cm of (416) 423-4206 <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> national government regulations. <br /> It 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 <br /> Qto be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment; OR,if I am a small quantity en tor,I have ma a good faith effort to minimize my we , <br /> generation and select the best waste management method that Is available to me and the c dfprd. <br /> Printed T ped r�e Hayes on WWof LLNL Signal u /! Mont; Day (Year <br /> LU 1,! F f ` > Ii L <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> uS Print /T ed Nams a natu Mo, <br /> o Da e i <br /> O P <br /> 0 18. Transporter 2 Acknowledgement of Re ipt of Materials <br /> R Printed/Typed Name Signill, Month Day Year <br /> z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I 121 <br /> t <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials cover y is manifest except as not m Item 19. <br /> T <br /> y Prin yped Name Signal Month Day Year <br /> G h N A tR%tvwer d <br /> S 8022 A(1/88) Do Not rite Below This Line <br /> A 8700-22 <br /> ev.9.88)Previous editions aro obsolete. <br />