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H135766 '- R 693 <br /> LAWRENCE LIVERMOnc NATIONAL LABORATORY ACCEPTABLE <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM Use Only Page 1 of 1 <br /> 1.Building No: 2. Room 3. RMMA: 10.Hazardous Outer Container/Retention Tank ID: Overpack? SehaCu d Was o nate: Vold Requisition: <br /> r ❑ Yes No Pro erties Dyes ❑No / _/ ❑DATE: <br /> oxic <br /> 4.WAA o: 5.W9tkplage End p� 6.Account No: 12,Outer Container 13.Outer Container Size: Initiats/Dat <br /> —/! - C' ? -� ❑Corrosive ❑ HWM Waste Run <br /> i Z Type: <br /> / / L �5 � ❑ 1 gal ❑330 gal e <br /> Box ❑ 5 gal ❑660 gal ❑Off-Site to LLNL RTO <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? <br /> No <br /> ❑ ❑ 7 gal ❑750 gal <br /> tY ( p ) ❑ Reactive ❑Can ❑30 gal ❑1000 gal Commercial Shipment WTO f <br /> ❑Yes, Activity Codes enter u to four): W W W W-- <br /> i t.Waste Form: ❑Carboy ❑55 gal ❑5000 gal ❑Secured Pickup <br /> Comments: ❑Solid ❑Drum ❑85 gal 171x1x1.5 it <br /> ED 2x4x7 ft HWM Field Pump Out <br /> Did this Waste Minimization effort begin in current calendar year? El Yes o CKLiquid Tank-Fixed <br /> Tank•Portable ❑4x4x7 it ❑ HWM Generated Waste <br /> 8.Profile No: 9.Directorate: 1 ❑Sludge 3e v gal <br /> H <br /> 1_�� <br /> "^ ❑Gas Other: Other ❑Cu ft ❑ <br /> Sewer:: DATE:_/_/_RSDR 19.QUANTITY <br /> #: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION <br /> per Item <br /> NO. H Normality* SAMPLE NO. CODE Amount unas <br /> b(£.sF_2- �L, tL C2oto, _Luk vt PC, <br /> .4- <br /> HMSHIP INGa — <br /> J U 9 1 94 f ---- --- -- <br /> -s k/ <br /> For RMMA Waste *Normality Required if pH s 2 or pH i 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 /> 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 Lj <br /> (if no,full rad analysis required) Generator Name(Print-Last,First): L-Code: Ext.: Inspected by HWM(Print Name-Last,First): Ext.: <br /> t� r <br /> 21.Was the waste exposed to particle 1 j (iL <br /> �Lt <br /> beams capable of inducing radioactivity SignaturA4�2�) <br /> ' Employee No.: Date: Signatur Employee No.: Date: <br /> by activation? Yes❑ No❑ /f 1/ Q(//, 2 /° / <br /> (If yes,full rad analysis required) ag J fly[ q3���` VV�� t" <br /> ITEM RCH RCH P Origin Form EPA NO. DTSC NO. MSDS NO. Hazardous Properties Handling Code: By: <br /> Prefix Code Code <br /> T C I R <br /> Date: Loc: <br /> CE If '3.20-3 2 L/N. El -1---1-- <br /> ❑ ❑ Chemical CompatibilityCode: <br /> ❑ ElY <br /> ❑ ❑ ❑ ❑ Department/Ge'nerating Waste. <br /> M Requisition Approval(Signature) <br /> ❑ ❑ ❑ ❑ rZ <br /> ❑ ❑ ❑ ❑ Emee No.: <br /> plo Date: <br /> ozlg 6e g- <br /> LL 5344-D(Rev.3193) 1600-10302 White—HWM Copy <br />