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H127067 693 <br /> ACCEPTABLE FO <br /> IL LAWRENCE LIVERMORE NATIONAL LABORATORY "" <br /> lacwnpatich with: <br /> ox.W/M HAZARDOUS WASTE DISPOSAL REQUISITION ❑ HWM Use Only Page 1 o,-.-' <br /> 1.Building No: 2. Room No: 3. RMMA: 10.Hazardous Outer container/Retention Tank ID: Overpack? Scheduled Waste Run Date: Void Requisition: <br /> b E3 Yes No Prop les: Qves ❑No --/ -/ ❑DATE: t _.._1__-- <br /> OX C t <br /> 4.WAA No: 5.Workplace End Date: 16.Account No: 72.Outer Container 13.Outer Container Size: tnitiais/D <br /> »» p. x ❑Corrosive ❑HWM Waste Run _} <br /> 3 [ __3--t-`b j_ '� t�L -_� 3 E,�;,,<�' Type: ❑ 1 gal ❑330 gal RTO ! �+ <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? [ L Tlgn table ❑Box ❑ 5 gal ❑660 gal L Oft-Site to LLNL <br /> 7 gal ❑750 al <br /> ❑Reactive ❑Can g ❑Commercial Shipment WTO <br /> ❑Yes, Activity Codes(enter up to four): WW____.__ W----- W___ 1 ;3 gat ❑1000 gal -- - <br /> 11.Waste Form: E71 Carboy ❑5000 al <br /> Comments: ��� C 5 gal 9� ❑Secured Pickup <br /> �❑ <br /> Solid L�Urum ❑85 gal ❑1xix1.5 It <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes ❑No [iJ, qwd ❑Tank-Fixed ❑2x4x7 It ❑HWM Field Pump Out <br /> __ ___ ❑4x4x7 ft <br /> ❑Sludge Tank-Portable ❑HWM Generated Waste <br /> 8.Profile No: 9.Directorate: q EJ gal <br /> Other:____ <br /> H P --_-- _ - - ❑Gas Other ❑C_u ft ❑ sewer: DATE:_/_/_RSDR It._.-_---- <br /> 14.ITEM 15.AQUEOUS ONLYF16ANALYSIS117 SOURCE 18.CHEMICAL!PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. pH No mabty� PLE NO. CODE �� <br /> -.. 4 wwv urs <br /> -- -- ------ - ---- <br /> CHI <br /> For RMMA Wast "Normality Required if pHs 2 or pH z 12.5 _— USE CONTINUATION FORM FOR AODtTIONAL ITEMS <br /> 20.Was the waste kept is ted from <br /> any operation that could have 22.Describe other controls used to prevent radioactive contamination: <br /> produced radioactive contamination23.1 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❑ No <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 GL Ft?� -- -.— jy_ —��? 3 53 IAt r CL <br /> beams capable of inducingradioactivity Date: Signature: Employee No.: Date: <br /> b activation? Yes❑ No - Y g Employee ee No <br /> r_ � Sin ure p Y <br /> Y � lb® <br /> (if yes,fuif rad analysis required) � �- - � -7 <br /> RCH RCH P EPA NO. DTSC NO. MSDS NO. Hazardous Properties Handling Code: By: <br /> ITEM Origin Form <br /> Prefix Code Code <br /> T C 1 R <br /> Date: Loc: <br /> I f P D El ❑ E:] Chemical Compatibility <br /> Code: <br /> PartmentGenerating Waste <br /> El : <br /> t_ +i9 <br /> HWM R ui provai:( ture) fQ <br /> El EJ 0 0 <br /> r 7�- <br /> - - 1 7 <br /> Employee N - te: <br /> _ x <br /> F <br /> LL 5344-8(Rev.3193) 7600-70302 Ak <br /> Green---C Copy <br />