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H135767 ACCEPTABLE FOR 693 <br /> LAWRENCE LIVERIVIOriE NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION fiwkl use only <br /> --- --------- <br /> I BL111d1Hg Il 110010 IN 3 RIJMA, 10, Hazardous Ouit.,containedRat.riti..Tank ID:j Overpack? scheduled Was;#Date,�, Void Requisition: <br /> t>L 12. 1 s I DATE: <br /> — ----- Ye_ No Properties. Oyes ONO <br /> 4 WAA -5 Wjr k p 7. X--- To <br /> - Initials/Date <br /> �nd 6,ACC0LJul1No3 12 Outer Container 13 OLIhJf Cowwner Stio HWM Waste Run <br /> e <br /> 11711q 76' Corrosive Type [A 1 gal x-]330 gal <br /> -1 - ------ . U Ignitable - -1 5 gal ❑660 gal ❑Off-Site to LLNL RTO,4 44' <br /> Waste Minimization Efforts Practiced During Generation of this waste? 11 Box <br /> X'110 F - E-1 7 gal F-1750 gal -I'c-ommercial Shipment <br /> Yes Activity Codes(enter tip to four): W W W W _1 Reaclive Can t-130 gal 1-11000 gal F! WTO <br /> C111111110116 11 Waste FormCarboy L-155 gal F-1 5000 gal Secured Pickup <br /> -------- XS011d Ll Drum L-1 85 gal Ll 1x1xI.5 If <br /> I)id uijs Waste IvIumnizatioti effort begin in current calendar year? L_1 Yes 1-1 Liquid TKTank-Fixed ❑2x4x7 It ❑HWM Field Pump Out <br /> file No: <br /> Tank-Portable 4x4x7 it Ei <br /> 8 Pro 9.Directorate. El El Gas SlUdge 4!< HWM Generated Waste <br /> _H _P L'T Other Other gal <br /> .,2� Elcuft DSewer: 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 <br /> Fe, IIA-i QL-lI Co NMAt r j I"'iN-t/q1N;/VJA L <br /> HW SHIP 13IN UOMPLETE <br /> j_U11 7- 1994 [JUL0 <br /> _ __ _------ BY.L'CZE2t_ <br /> _ ____ I- - <br /> For RMMA Waste it Normality Required pH 2 or rill a 12 5 t ISE C4N TIN6A TION FOPA I FOR ADDI TIONAI 11EAI S <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 23.1 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 Fedoral prosecutluil by iotentioriilly <br /> (using a glove box,vent hood,etc.)? providing false information. <br /> Yes FI No <br /> (it 110 full rad analysis required) Generator Name(Pri Last,First): L-Code: Ext. Inspected by HWM(Print Name-Last,First): Ext.: <br /> 21 W,jsthe waste exposed to particle 1Z <br /> N �m F <br /> h­jiris capable of inducing iadiudclivity Slynat Employee No.: Dat Signature: _;Ioyee No: Date. <br /> bV­11v"ll(Al? Yes FI No [-I <br /> ill yt!.' hill[ot 1,11 I'trybis -2 <br /> ITEM RCN RCH P Origin Form EPA NO. DTSC NO. MSDS NO. Hazardous Properties <br /> Handling Code; By: <br /> Prefix Code Code T C I R <br /> Date: Loc: <br /> 5' 01 <br /> Chemical Compatibility Code: <br /> De rtment Generating Waste: <br /> 300 lime <br /> HWM Requisition Appro 1:( ignature) <br /> Emplo ee No.: Dat <br /> C)**?-'7 6-7-qA <br /> L L 5544-13(Hev.3,93) 7600-70302 White--HWM Copy <br />