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State of C.ahtornia—tnvlronmental rrotection Agency <br /> Form oved OMB No.2050-0039(Expires 9-30-94) See Instructions on back of page 6. Department of Toxic Sy ':ontroI <br /> �Siease print or type. Form designed for use on elite(1?pitch) writer. Sacramento, <br /> UNIFORM HAZARDOUS nerator's US EPA ID No. Manifest Documen 2. Page 1 Information in the she <br /> is not required by Feder <br /> WASTE MANIFEST 1Al2 8 19 10 10 11 12 15 A 14 9 1 4 1 1 8 13 of 4 <br /> 3. Generator's Name and Mgiling Address t'� <br /> h LAWRENCE UVEAMORE NATIONAL LABORATORY <br /> in <br /> 7000 East Avenue, l.ivermona,CA 94550 <br /> to 4. Generator's Phone <br /> 610 )422-1925 Af ni A. WiiL, L-62000 <br /> d 5. Transporter 1 Company Name 6. US EPA ID Number <br /> ao Lawm L�mrmom Na*ma l LaboralOry z <br /> JA 28900 11 12584 � a <br /> r/ 7. Transporter 2 Company Name 8. US EPA ID Number , q <br /> U 41 <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number_ <br /> 00 <br /> 000fiarrtic Lnvirnmentscl Technologies Corp. <br /> 2{181y Rd East Palo Alft�, CA 94303 �' <br /> �QD009452657 � , <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> LO <br /> Z No. Type Quantity Wt/Volk( YNumber <br /> 3 Diems Fuel, 3, NA i , 01 <br /> E {� © 6 0 2 P a �0 <br /> ootat <br /> E Hazardous Waste Liquid n.o.&, 9, NA3082, Ill i <br /> d A (F002, FOOS) 0 i D M 0 O 4 is � <br /> e <br /> O T C. <br /> � a <br /> ao o RO Hazardous Wastes Liquid n.o.s,, 9, NA3082, III <br /> w R (01005, D008) Ro (1 008) 01011 D M0101117 P <br /> Z d. <br /> LU <br /> RO Hazardous Waste Uquid n.o.s., 9, NA308Z Ili <br /> LU (13040) RO(DO40) O jo 11 P � <br /> A f ,� <br /> -13 <br /> 01 <br /> ALU � . <br /> Z <br /> 15. Special Handling Instructions and Additional Information <br /> Q EMERGENCY CONTACT: (510) 447-5880 DOT ER Guide#27.31 1T Job# 152298 <br /> Wear prim � <br /> e g 40le handling. Reference Release Number 1WY on the invoice. <br /> These materi»Ils are NOT rachoactively contaminated. LLNL 5hipDoc#L-48198 j <br /> Cr 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 /> n� Q 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 /> lU <br /> -i If I am a large quantity generator, I certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <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 /> 1, N threat 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 /> w0Z waste management method that is available to me and that I can afford. <br /> Q Printed/Typed Name Signature Month Day ear <br /> >- Richard i3. i.oden on bW'>alf of LLNL !� G ,? .? /�. ✓ <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> LLJ A Printed/Typed Name / / Signature — / Month Day Year <br /> N J <br /> tiIO 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> �—� W TU. Printed/Typed Name Signature Month Day Year <br /> p O R <br /> N19. Discrepancy Indication Space <br /> Q F <br /> 1 U A O <br /> (^1 I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered b is rportifest/excesli as noted in Item 19. <br /> T Printed/Typed Name Signature Month a� C/ <br /> �-� Y 0215 ��� ids � <br /> �1 DO NOT WI. TE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (12/91) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />