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H127069 ACCEPTABLE F0,'_ 693 <br /> IL LAWRENCE LIVERMORE NATIONAL LABORATORY <br /> li"oox wr HAZARDOUS WASTE DISPOSAL REQUISITION 0 HWM Use Only <br /> Page 1 of <br /> 1.Building No: 2. Room No: 3. RMMA: iti <br /> / 10.Hazardous Outer Container/Retention Tank ID: Overpack? scheduled waste Run Date: Void Requison:^ k ' <br /> Qv El L4' No Properties ❑Yes ❑roo — / _—/ _ ❑DATE: <br /> �oxic <br /> 4. AA No: 5.Workplace End Date: 6.Account No: 12.Outer Container 13.Outer Container Size ❑HWM Waste Run ale <br /> � I-f p.- ® 1- ❑Corrosive f Type ❑ 1 call ❑330 gal RTO - <br /> 3 ^✓ ( �❑table Box Q 5 gal 660 gal I Sits to LLNL — <br /> 7.Waste Minimization Efforts Practiced During <br /> Generation of this Waste.' t- o - f 7 gal ❑750 gal <br /> ❑ Reactive I ❑Can ❑Commercial Shipment WTO / <br /> ❑Yes, Activity Codes(enter up to four): W__ ____ W______ W _-__._ W- L_130 al 1000 gal ----_ - ----- <br /> 11.Waste Form ❑Carboy -- <br /> Comments: I j gal ❑5000 gal )Secured Pickup <br /> ❑,,S//aid �m ❑85 gal ❑lxtxl.5 It <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes ❑No L;-1 quid I ❑Tank-Fixed ❑2x4x7 ft ED HWM Field Pump Out <br /> ----- [A4x4x7 it <br /> Profile No: 9.Directorater EJSludge ❑Tank-Portable ❑ I ❑HWM Generated Waste <br /> H P -- -'©_,2---�+ ❑Gas OtherOther cu---------- -- - __ ❑cu It (❑Sewer: DATE:_/_/ RSDR#:--------- <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 1.7 SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION X19.QUANTITY <br /> NO. A—.1pH Normality SAMPLE NO CODE ue uen <br /> A—.1units <br /> j I <br /> kid <br /> For FIMIVIA Waste 'Normality Required it pHs 2 or pH z 12.5 USE CONTINUATION FORM FOR ADDITIONAL ITEMS <br /> 20.Was the waste kept isol d from <br /> any operation that could have 22.Describe other controls used to prevent radioactive contamination: <br /> produced radioactive contamination �3.1 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 El <br /> (if no,full rad analysis required) Genera/tor Name"^(Priinnt-Last,First): L-Code Ext.: Inspected by HWM(Print Name-Last,First): Ext.: <br /> 21.Was the waste exposed to particle C L- C7 6 + S-7 I TDP <br /> beams capable of inducing radioactivity Signature Employee No.: Date. Signature: 'Employee No.: Date: <br /> by activation? Yes❑ No❑ e / Q <br /> (tf <br /> yes.full rad analysis required} — - / ® 3 t 16�/_ <br /> -- ---- -- <br /> RCH RCH P EPA NO. DTSC NO. MSDS NO. Hazardous Properties Handling Code: By. " <br /> ITEM Origin Form Pe <br /> Prefix Code Code <br /> T C I R <br /> s Date: Loc: <br /> 2� I. M Z <br /> /—_/--- <br /> r� Chemical Compatibility Code: <br /> 6,1 t ❑ ❑ ❑ ❑ I L. <br /> ❑ ❑ ❑ O Depaftment Generatin -Waste: <br /> ke <br /> ❑ ❑ ❑ ❑ HwM R i M Approval: ignet ) <br /> 9 <br /> 0 ❑ Employ o.: Date y <br /> LL 5344-B(Rev.3/93) - 7600-70302 <br /> " Green--C - "'9rCOW <br />