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H127070 ACCEPTABLE FOR__""93 .,. <br /> IL LAWRENCE LIVERMORE IvATIONAL LABORATORY <br /> h%virnpati V&&' r <br /> OX,WYAR HAZARDOUS WASTE DISPOSAL REQUISITION ❑ HWM Use Only Page 1 _oto <br /> 1.Building No:; 2. Room No: 3. RMMA: 10.Hazardous Outer container/Retention Tank ID: Overpack? scheduled Waste Run Date: Vold Requisition: <br /> ❑ Yes �No Prop les: FjYes ❑No - f !._ ❑DATE:_-_/_ / <br /> oxic <br /> 4.WAA No: 5.Workplace End Date: 6.Account No: 12,Outer Container 13.Outer Container Size: Wtials/Date <br /> t G 8 ❑Corr ive El HWM Waste Run <br /> of?4 13 --��/-_ - _ - I l_-Q 1__ Type: ❑ 1 gal ❑_ 330 gal RTO <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? o gnitable ❑Box ❑ 5 gal (_7 660 gal -Site to LLNL <br /> ❑Reactive ❑Can ❑ 7 gal ❑750 gal ❑Commercial Shipment <br /> ❑Yes Activity Codes(enter up to four): W,__ _ W--__ W---__ W-_—__ [�],3�0 al ❑1000 gal INTO <br /> ------ ---f---— -_-- <br /> 1 L Waste Form ❑Carboy L_t ❑5000 al <br /> Comments: 5 gal g ❑Secured Pickup <br /> --- ❑Solid 5 Grum ❑tx1x1.5 It <br /> ❑85 gal <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes ❑No E;;- quid ❑Tank-Fixed ❑2x4x7 It ❑HWM Field Pump Out <br /> 8.Profile No: 9.Directorate: ❑Sludge <br /> EJTank-Portable ❑4x4x7 It ❑HWM Generated Waste <br /> � ❑gal <br /> H P - yJ-_ f ❑Gas Other Other: <br /> ❑cu It <br /> ❑Sewer: DATE:_!__/ RSDR <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17 SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO- SAMPLE NO. CODE <br /> pH Normality* Asoaum un2<0 <br /> 11,75 JP9 <br /> I <br /> 7 <br /> tke <br /> For RMMA Waste *Normality Required if pHs 2 or pH 12.5 USE CONTINUATION_FORM FORAOD_ITIONA_t_ITEMS <br /> 20.Was the waste kept isolated from <br /> any operation that could have 22.Describe other controls used to prevent radioactive contamination: <br /> produced radioactive contamination 23.I 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)? <br /> Yes F-1 No C7 providing false information. <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 �L 4�:, /2 L/C e- -3_L_.__. 3S31r <br /> beams capable of inducing radioactivity Signature: Employee NNo'") Date: Signature: Employee No.: Dale: <br /> activation? Yes F-3 <br /> No D <br /> 4 <br /> by (It yes,furl rad analys s requ ed) — b _ D 1 —,�—� - -- 2 <br /> ITEM RCH RCH P Origin Form EPA NO. GTSC NO. MSDS NO. Hazardous Properties Handling Code: By: <br /> Prefix Code Code <br /> T C 1 R <br /> SM <br /> } ���. Date:f----f -- Loc: <br /> V ! d #7 - <br /> �'✓ ❑ ❑ ❑ ❑ Chemical Compatibility Code: <br /> 1t <br /> ❑ ❑ ❑ ❑ Department Generatin Wast: <br /> ❑ ❑ ❑ HWM Re i '' Approval: <br /> l <br /> ❑ ❑ ❑ F] Employee o: ate: <br /> LL 5344-B(Rev.3/93) 7600-70302 <br /> (are@n—C(#Bts'i1r4E7 i,S7py <br /> .p <br />