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H127062 `93 <br /> ILS LAWRENCE LIVERMORE 14ATIONAL LABORATORY it <br /> ! pz w7AR HAZARDOUS WASTE DISPOSAL REQUISITION El Use Only Page 1 of <br /> 1.Building No: ..win Ivo: 3. RMMA: 10.Hazardous Outer Container/Retention Tank ID: Overpack? Scheduled Waste Run Date: Void Requisition: c <br /> 3 f ❑ Yes �No Prap les: — � p <br /> oxic <br /> �� © f--- -t DATE:--, ---j-- <br /> 4.WAA No: 5 Workplace End Date: 6 Account No 12.Outer Container 13,Outer Container Size Initials/Da <br /> /� p �t �+ ❑Corrosive I]HWM Waste Run <br /> 3 A4 t) j® j-! J-4-L -f--_®�_ Type: ❑ 1 gal ❑330 gal <br /> 7,Waste Minimization Efforts Practiced During Generation of this Waste? E4-1g`nitable E:]Box ❑ 5 gal 1:1660 gat -Site to LLNL RTO <br /> D Reactive ❑Can (_l 7 gal ❑750 gat El Commercial Shipment El Yes, Activity Codes(enter up to four): WW W— W----__ LJ 3 al ❑1000 gal p INTO <br /> Comments: '11.Waste Form: El Carboy g ❑5000 al p <br /> 5 al g ❑Secured Pickup <br /> � Solid rum ❑85 gal ❑txlx1.5 it <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes ❑No Ea tquid ❑Tank-Fixed ❑2x4x7 It D HWM Field Pump Out <br /> ❑ ❑ <br /> 8.Profile No: 9.Directorate: ❑Sludge Tank-Portable 4x4x7 ft� ❑HWM Generated Waste <br /> H P 0� _ ❑Gas Other Other. gaI <br /> D cu it ❑Sewer: DATE:—/—/__RSDR#:-------_.._ <br /> � ) <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE--_ 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. SAMPLE NO.I CODE <br /> pH Normality Amom <br /> -- MS p.S Cil E-0 ' <br /> -- -- --- -- --- -- --------- - -- <br /> For RMMA Waste *Normality Required if pHs 2 or pH a 12.5 USE CONTINUATION FORA?FOR ADDITIONAL ITEMS <br /> 20..Was the waste kept isolated from <br /> ally 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❑ No❑ <br /> (If no,full rad analysis required) Generator Name(Print--Last.First): L-tCode: Ext.: Inspected by HWM(Print Name-Last,First): Ext.: <br /> 21.Was the waste exposed to particle Q� ��----L- /�f2(f --.._-._ I CEJ 3 4- - �� -, GSC t�"� j,,� -— ---'s sS-at_.- <br /> beams capable of inducing radioactivity Sign ure: I Employee No.: Date: Signature. Employee No: Date: <br /> by activation? Yes II No ❑ <br /> (If yes.full rad analysis required) r' ✓'� ' 1 -� <br /> ITEM RCH RCH P Origin Form EPA NO. CTSC NO. MSDS NO. Hazardous Properties Handling Code: By. <br /> Prefix Code Code <br /> T C 1 R <br /> t$4 Date: Loc: <br /> ❑ ❑ ❑ ❑ Chemical Compatibility Code: <br /> L <br /> 1-1 E] El 1:1D pe went Generati Waste: ta^ r <br /> HWM R s provat: <br /> ❑ ❑. ElEmp yee te: <br /> i <br /> < Cr <br /> LL 5344-8(Rev.3/93) 7606-70302 t <br /> Green-Cof��Copy <br />