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H127066 ACCEPTABLE FOP 6231 <br /> IL LAWRENCE LIVERMORE i,4,F%TIONAL LABORATORY <br /> incompatible With: <br /> OX,W/AR HAZARDOUS WASTE DISPOSAL REQUISITION El HWM Use Only Page_L-of <br /> 1.BuildAg Not 12. Room No: 3. RMMA: 10.Hazardous Outer Container/Retention Tank ID: I overpack? Scheduled Waste Run Date: Vold Requisition: <br /> 34& 0 Yes [ANo �ries: Elyse El- -- DATE;_____J_ <br /> — Toxic <br /> 4.WAA No. 5.Workplace End Date: 6.Account No-- <br /> C sive ❑12 outer Container 13.Outer Container Size: 0 HWM Waste Run Initials! <br /> Type: <br /> 93 + 1 - , El 1 gal 0330 gal <br /> 0 C <br /> 7.Waste Minimization Efforts.Practiced During G [A<-Site to LLNL RTQ �-* <br /> Generation of this Waste? E�< E-?'rg�n,a b I e E71 Box, 0 5 gal El 660 gal <br /> El Reactive ❑Can 0 7 gal D 750 gal 0 Commercial Shipment <br /> DYes, Activity Codes(enter up to four): W---_- W-- -- W---- W_.-_--- 0 galWTO <br /> E 30 gal E1100 <br /> Comments��,'� 11.Waste Form ❑carboy E415'-gal []`5000 gal D Secured Pickup <br /> Solid [;��F,um El 85 gal 0 1x1x1 5 It <br /> Did this Waste Minimization effort begin in current calendar year? 0 Yes EJ No E�Kqwd D Tank-Fixed D 2x4x7 It El HWM Field Pump Out <br /> EJ Tank-Portable 4x4x7 It <br /> 8.Profile No: 9.Directorate. El Sludge gal F1 HWM Generated Waste <br /> H P P A./ ❑Gas Other-, !;met <br /> cu ft DATE:—/----I —RSDR#: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL PHYSICAL DESCRIPTION 19-QUANTITY <br /> NO. * SAMPLE NO. CODE Pe,tilt <br /> ts <br /> pH _Normality . - II A—, <br /> V AJ V 45- j e-s'e <br /> 100 <br /> 2, <br /> AV <br /> For RMMA Waste Normality Required if pH s 2 or pH z 12.5 USE CONTINUATION FORM FOR ADDtTIONAL ITEMS <br /> 20.Was the waste kept isolatedYrom <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.)? providing false information. <br /> Yes D No El <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 particle C 834 <br /> beams capable of inducing radioactivity <br /> Signature: Employee No.. Date: ignature: Employee No. Date- <br /> 1by activation? YesD No <br /> (If yes,full rad analysis required) i <br /> X -71.3 A. <br /> ITEM RCH RGH P Origin Form EPA NO. LITSC NO. MSDS NO. Hazardous Properties Handling Code: By: <br /> Prefix Code Code <br /> T C I R <br /> Date: Loc: <br /> lilt P <br /> Pam+ kxdo <br /> I <br /> *71El 0 EJ El Chemical Compatibility Code: <br /> k L <br /> Dwart t Generating Voste: <br /> Xv <br /> HWMr',Approval!*. r <br /> 0 Date: <br /> F-1 Em <br /> LL 5344-B(Rev.3193) 76OD-70302 <br /> Geeen­aCo 0 f cow <br />