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H177 <br /> . 4. LAWRENCE LIVERMOn� NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM Use Only Page I <br /> 1.Bui No: 2.yRoom No: 3. RMMA: 10.Hazardous Outer Container/Retention Tank ID: lOverpack? scheduled waste Run te: Void R uisition: <br /> eq <br /> V Pr erties: « [:]No <br /> �9 <br /> s I D ❑ Yes o ❑t ❑ —L 1 2 I� ❑DATE: / e <br /> oxic <br /> 4.W o: 5 kplage d 6.Account No: 12.Outer Container 13.Outer Container Size: Initis <br /> / 1 L ��_ ❑Corrosive Type: ❑ 1 gal ❑330 gal ❑HWM Waste Run e <br /> l v ❑ Ignitable ❑Box ❑ 5 gal ❑660 gal ❑Off-its to LLNL RTO <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste. No 4— <br /> ❑ Reactive ❑ 7 gal ❑750 gal <br /> ❑Yes, Activity Codes(enter up to four): W-_. W W yy_ ❑Can ❑30 gal ❑1000 gal Commercial Shipment WTO <br /> 11.Waste Form: Carboy ❑55 al ❑5000 gal ❑Secured pickup <br /> Comments: 9 P <br /> Solid ❑Drum El 85 gal ❑1x1x1.5 ft <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes %0 ❑Liquid Tank-Fixed ❑2x4x7 It ❑HWM Field Pump Out <br /> 8.Profile No: 9.Directorate: � ❑Sludge <br /> ❑Tank-Portable ❑4x4x7 It ❑HWM Generated Waste <br /> Other algal <br /> H P El Gas Other: ❑cu ft ❑sewer: DATE: RSDR is <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 Lim$ <br /> l A® WQ)CtPG7rzF <br /> S7IlJ ®C,® <br /> BY <br /> For RMMA Waste *Normality Required if pHs 2 or pH a 12.5 USE CONTINUATION*10 FOA 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 /> 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 Federal prosecution by intentionally <br /> (using a glove box,vent hood,etc.)? providing false information. <br /> Yes❑ No❑ <br /> (If no,full rad analysis required) Ge rator Name(P <br /> +rin <br /> ©t–Last,First): L-Code: Ext.: Inspected by HWM Print Name–Last,First): jExt.:21.Was the waste exposed to particle izG I/�� �� OS;vo beams capable of inducing radioactivity Signatur b Employee No.: Date: Si nature: Employee No.:by activation? Yes❑ No ❑(If yes,full rad analysis required) g37393 / <br /> ITEM RCH RCH P Origin Form EPA NO. DISC NO. MSDS NO. Hazardous Properties Handling Code: By: <br /> Prefix Code Code <br /> T C I R <br /> Date: Loc: <br /> o Chemical Compatibility Code: 1 <br /> ❑ ❑ ❑ Department Generating Waste: <br /> ❑ ❑ ❑ D HWM Requisitio Approval:( ure) <br /> Atli <br /> ❑ ❑ ElEmploy No.: Date: <br /> El q01-7 IT ull, <br /> LL 5344-B(Rev.3/93) 7600-70302 <br /> Whits—HWM Copy <br />