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State of California—Environmental Protection Agency <br /> Form Apprroved OMB4No.2050-0039(Expires 9-30-94) Sem lintCUctions on ha page 6. r art ent of Toxic Substances C <br /> Please print or type. form designed for use on elite(1 <br /> typewriter is $acromento,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 law. <br /> WASTE MANIFEST CI Al21819101019101010 2 9 .4 1 2 3 8 of 1 <br /> 3. Generator's Name and Mailing Address <br /> LO Lawrence Livermore National Labomtory,'Sile 800 <br /> LO 7000 East Avenue,Livermore, CA 54550 <br /> 4. Generator's Phone (510) 422-1925 Attn:A Wilt L:-620 <br /> 00 <br /> O 5. Transporter 1 Company Name 6. US EPA ID Number <br /> ao Erickson; Inc <br /> CAD n 019141616131912 <br /> -+ 7. Transporter 2 Company Name 8. US EPA ID Number <br /> Q <br /> U <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> c-1 O ERICKSON INC. <br /> U- 255 Parr Blvd., Richmond, CA 94801 <br /> .� CAD 10 10 1914 16 16 13 19 12 <br /> MM 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12• Containers 13. Total 14. Unit <br /> ♦�Wy� Z p ( g Pe PP 9 - No. T e Quant - Wt/vol <br /> v1,/ <br /> 3 G Non RCRA Hazardous Waste,Solid (Empty Containers Last Containing <br /> N E Diesel Fuel)(with associated piping) 01011 T P O 2 O O P <br /> do N. b. <br /> 0o E <br /> CN R <br /> A <br /> T C. <br /> 0 <br /> R <br /> W <br /> Z d. <br /> W <br /> V <br /> ,W <br /> N. <br /> Z <br /> O <br /> O. <br /> h <br /> W <br /> J <br /> Q <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> a EMERGENCY CONTACT: (510) 447-6880 <br /> Z Wear protective clothing while handling These materials are NOT radioactively contaminated. <br /> LU <br /> HWM Requisition NumberH135774 Tf1NK 9710lU1 ,IQ <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 /> 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 /> U t <br /> 1 <br /> ...i If I am a large quantity generator, 1 certify that I have 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 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> 4 threat to human health and the environment;OR, if I am a small quantity generator,I have made a <br /> N 9 tY 9 good faith effort to minimize my waste generation and select the best <br /> � waste management method that is available to me and that I can afford: <br /> Q Printed/Typed Name Signature 99 4 <br /> n� ayL :Year <br /> Rioftutd 8 Lodan on bahatf of LLNL C/i <br /> V <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> OW n Printed/Typed N e <br /> NSignature Monthay� Year <br /> W <br /> s //tel f Q r f <br /> PIn 177 1 <br /> We 18. Transporter 2 Acknow dement of Receipt of Materials <br /> T Printed/Typed Name Si nature <br /> O R g Month Day Year <br /> N19. Discrepancy Indication Space <br /> Q f <br /> V A <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest exce t as noted in Item 19. <br /> Y i ted/Typed Name Sig re %Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> t <br /> Yellow TSDF SENDS THIS COPY TO.GENERATOR W6IN 30 DAYS <br /> DISC 8022A (7/92) (Generators:who submit hazardous waste for.fraifsport oufof sfa14, <br /> EPA 8700-22 <br /> produce;completed copy of this copy and send-4o,DTk ithin 30 Joys.) <br />