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,- H1314b4 <br /> LAWRENCE LIVERMOhE NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM use Only Page t of <br /> 1.Building No: 2, Room No: 3. RMMA: 10.HazardousOuter Container/Retgntion TanktQj Overpack? scheduled waste Run Date: Void Requisition t 4 <br /> IOU-klj Pro erties <br /> e.— ❑ Yes No P r�5 . e t .,; t "ie, Na,n ❑DATE c <br /> Toxic <br /> 4.WAA No, 5.Workplace End D te- 6.Account o: 12.Outer Container 13.Outer Container Size. InitlalsJDat <br /> WM Waste„Run <br /> e-i � / 3 _ ❑Corrosive TYpe: ❑ 1 gal ❑330 gal <br /> ❑ Ignitable Box ❑ 5 al ❑660 al ❑Off S$e to LLNL RTO <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste. o ❑ 9 g <br /> ❑ Reactive ❑ 7 al ❑750 gal yq�> <br /> ❑Yes, ActivityCodes enter u to four): W W W W ❑Can g C�Cornmerclal Shipments < <br /> ( P ) ❑30 gal ❑1000 gal WTO <br /> 11.Waste Form: ❑Carboy <br /> Comments: ❑55 gal F-15000 gal ❑Secured Pickup r :, <br /> olid ED Drum <br /> 085 gal ❑lxixl 5 it <br /> Did this Waste Minimization effort begin in current calendar year? El Yes ❑No ED Liquid ank-Fixed ❑2X4x7 ft ' M'!= UhIp+OU Ck <br /> 3 <br /> 8.Profile No: 9.Directorate: Sludge Tank-Portable .��® ❑4x4xJ ft WMt 9 yyj sta <br /> +(�� ��. _z Qttet7k <br /> H_P---- —L_ ❑Gas Other. Other: <br /> ❑cu ft Se erg^ 1 OATk� Si7 <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO, H Normality SAMPLE NO. CODE per Item <br /> Amount Unha <br /> �.Z v� <br /> HWM SHIPPING <br /> MAR 719 <br /> For RMMA Waste V Normality Required if pH s 2 or pH a 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 /> producedradioactive contamination 23.1 certify,to the best of my knowledge,that the information provided on this requisition is correct.I u an I be I' to State and Federal prosecution by intentionally <br /> (using a glove box ,vent hood,etc.)? providing false information. <br /> Yes❑ No❑ <br /> (1f no,full rad analysis required) Generator Name(Print—Last,First): L-Code: Ext.: Inspected b HWM(Print Name Last First): Ext <br /> 21.Was the waste exposed to particle 73 35 O ' h <br /> beams capable of inducing radioactivity <br /> by activation? Yes❑ No❑ Signatur , Employee No.: Dat : Signature Employee No� , Date <br /> (If yes,full rad analysis required) &?S7,3� 3C <br /> i. fi $ *t J v <br /> ITEM iCHr P Origin Form EPA NO D�S`Ch10 �� } ��r1UISpS, 0 � azardousPro' ides ,v- andnngcode:'� gy <br /> Pnpflx Code Code s <br /> Date: <br /> Loc: <br /> .r Chemical Compatibility Code <br /> ❑ ❑ ❑ ❑ Depart ntGene tin`Weals <br /> oll <br /> / Pp►►P u <br /> HW e <br /> ❑ ❑ ❑ <br /> EITTploys N ru <br /> ,� . <br /> _ LL 5344-B(Rev.3/93) 7600.70302 Whlte--HWM <br /> sow LL <br />