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H127071 <br /> IL <br /> 6War _ t <br /> 93 <br /> 1 htcorn <br /> � LAWRENCE LIVERMORE NATIONAL LABORATORY ACCEPTABLE FOR--a <br /> .. <br /> ox,W/M HAZARDOUS WASTE DISPOSAL REQUISITION ❑ HWM Use Only Paget of ; <br /> 1.AN: 2. Room No: 3. RMMA: 10.Hazardous Outer Contalner/Retention Tank ID: I Overpack? Scheduled waste Run Date: Void Requisition: <br /> Properties: ❑Yes ONO(� ❑ Yes E4—No / !— ❑DATE: <br /> I�,in oxic <br /> 4.WAA No: 5.Workplace End Date: 6.Account No: 12.Outer Container 13.Outer Container Size: Initials/D <br /> 1 • ED Corrosive ®HWM Waste Run <br /> 8 ,� s Q 4- - -T�_ _ - 3 Type: ❑ 1 gal ❑330 gal _ <br /> �itable ❑Box ❑ 5 gal El 660 gal �ff-Site to LLNL RTO <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste?. ElNo <br /> ❑Yes, Activity Codes(enter up to four): W__ WWW ❑Reactive ❑Can ❑ 7 gal D 750 gal ❑Commercial Shipment __/ <br /> 30 <br /> at 1000 gat WTO --_-_ <br /> 11.Waste Form: ❑Carboy <br /> ❑ 5000Commentsga! Secured Pickup[?Drum 85gal <br /> ❑1xlx1.5 It <br /> Did this waste Minimization effort begin in current calendar year? ❑Yes EmeLiqu,cl ❑Tank-Fixed ❑2x4x7 It ❑HWM Field Pump Out <br /> ❑ <br /> 8.Profile No: 9.Directorate: ,, ` ❑ Sludge -Portable 4x4x7 ft dge � ❑HWM Generated Waste <br /> _� ❑Gas Other. Other gal <br /> P ---- JV ❑cu ft ❑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 Normatit amount u�ts <br /> 5 l <br /> F VP <br /> For RMMA Waste °Normality Required if pHs 2 or pH z 12.5 _ _ USE CONTINUATION FORM FOR ADDITIONAL 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 23.11 certify,to the best of my knowledge,that the information provided on this requisition is correct.f 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 L / V �3 14 gas-7,U 21/ 3s <br /> beams capable of inducing radioactivity JP- <br /> Signature: Employee No: Date: Signature: Employee No.: Date; <br /> by activation? Yes No F] / <br /> (If yes.full rad analysis required) / J / .3'�`' f �� •2Z <br /> ITEM RCH RCH P Origin Form EPA NO. DTSC NO. MSDS NO. Hazardous Properties Handling Code By: <br /> Prefix Code Code <br /> T C I R <br /> Date: Loc: <br /> r ❑ ❑ ---/—/— — <br /> L� ❑ El ❑ Chemical Compatibility Code: <br /> t_J ❑ ❑ 1--] D rtm t Generating w <br /> r <br /> r <br /> J <br /> r <br /> LL 5344-B(Rev.3193) 7600-70302 <br /> Copy <br />