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Sfote +Ijfor 'nvironmerdol Protection Agency <br /> F Ap ved OM o.2050-0039(Expires 930-94) See Instructions on back of 6. Department of Toxic Substances Control <br /> Please print or type. Farm designed for use on elite(12-pitch)w er. W Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFEST C A 2 8 9 0 0 9 0 0 0 2 91 41 1 2 2 of 2 <br /> 3. Generator's Name and Mailing Address <br /> 0 Lawrence Livermore National Lat�oratory, Site 300in <br /> Corrals Hollow Road, Tracy, CA 95376 <br /> C4 4. Generator's Phone (510) 422-1925 Attn1 A. 10�ilt L-620 <br /> 5. Transporter i Company Name 6. US EPA ID Number <br /> Co Lawrence- Ln,ermore National Lar.-oratory <br /> CA 289001 2584x <br /> -"r-r 7. Transporter 2 Company Name 8. US EPA ID Number <br /> U � <br /> =� 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> 00 Z <br /> C3?p Lawt^en<)e I tvermore National t_a1'os,ptor.y <br /> LO 0 ;000 East Ave., Livermore, CA 94 50 <br /> C A 2 8 9 0 0 1 �2 5 8 4 <br /> V 12. Containers 13. Total 14. Unit <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Ty22 Chianti Wt/Vol � <br /> 00 S a. r <br /> N RU Hazaraous Waste t-.iquid n.o.s , 8 iVd JU82 Ill <br /> C�7 G 0002,17005), Ria (Do04, DoOs D0t18 DP 10 DO 18) 0 0 1 DM 0 0 4 5 0 P <br /> 6i E <br /> opo N b. " <br /> co RC Waste Paint Related Material, 3, LIN 1263, Ill e v <br /> 6 R RO (Dtm1, D006, D007, D008) 0 0 6. D Iii 0 3 6 0 0 F' <br /> v A <br /> 00T RQ Waste Asoestos, 9, NA2212, Iii <br /> R 00 1 D M 00250 P � 6 <br /> Z d <br /> LU RCS Waste Diesel Fuel, 3, NA 1993, Ill <br /> RQ ( D001) 006 D M 03600 PLU <br /> �b <br /> LU <br /> c. 9 d. q <br /> O 15 Stial Honailing Instructions and Additional Information <br /> EMM106ENC`r CONTACT: M.N. Hayes 510 447.6w30 <br /> z <br /> W� T hese materials am NOT ditrCt1Ve{y contaminated. <br /> N <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> < packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If 1 am a large quantity generator, I certify that I hove a program in lace to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> g q tY g Y P 9 P tY 9 9 <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> Nthreat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> 09 waste mono ement method that is available to me and that I can afford. <br /> 0 Printed/Typed Nome Signoture Month Day Year <br /> Richard© Loden,an behalf of L.LNL 210 71 <br /> Z t 17. Trons orter 1 Acknowledgement of Recei t of Materials <br /> A P nted/Typed `Noeme �j y 5i9nature ,i Month Day Year , <br /> jo <br /> P <br /> A 1 TERnsg or 2 Acknowled a nt of Receil2t of Materials <br /> 1u T Printed/Typed Name Signature Month Day Year <br /> si, <br /> Q Ep I I I I I <br /> UJ 19. Discrepancy Indication Space <br /> 4 F <br /> V A j <br /> Z C <br /> 1 <br /> L <br /> 120, Focili Owner or o erotor Certification of receipt of hazardous materials covered by this manifest exce t as noted in Item 19. <br /> T Print//Typed Nome Signature Month Day Year <br /> DO NOT WRITE BELOW T,,419 LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8704--22 produce compleied copy of this copy and send to DTSC within 30 days.) <br />