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H135757 ACCEPTABLE FOR 693 <br /> LAWRENCE LIVERMOr1E NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION ❑ HWM Use Only <br /> 1 Building No 2 Room N 3. RMMA. 10. Hazardous Outer Container/Retention Tank ID: Overpack? scneaurea waste oau: Void Requisition: <br /> co S, ❑ Yes No Properties: []Yes ONO _ ❑DATE: <br /> 4 WAA 5.W rk aI ce nd Qat 6.Account No: Toxic <br /> P 1 12.Outer Container 13 Outer Container Size: ❑HWM Waste Run Initials/Date <br /> �� � / / l- , 3 -�j j- ILLIII Corrosive TYPe: ❑ 1 gal ❑330 gal <br /> ❑ Ignitable Box ❑ 5 al ❑660 al ❑Off-Site to LLNL RTO 1� <br /> 7,Waste Minimization Efforts Practiced During Generation of this Waste. �Rlo ❑ 9 9 <br /> ❑Reactive ❑Can ❑ 7 gal 11750 gal l�Commercial Shipment 4L <br /> [-]Yes, Activity Codes(enter up to four): W,__-_- _ WW____,_ W____- [_�30 gal ❑1000 gal P WTO 1 <br /> 11.Waste Form: ❑Carboy ❑55 al [__15000 gal ❑ <br /> Comments:-- Solid ID Drum gSecured Pickup <br /> �p�.� TK <br /> ❑85 gal ❑1xtx1.5 ft <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes tolvo ❑ Liquid LC1 Tank-Fixed ❑2x4x7 It ❑HWM Field Pump Out <br /> ❑Sludge ❑Tank-Portable ❑4x4x7 It 8.Profile No: 9.Directorate: g ❑ <br /> '<gal HWM Generated Waste <br /> H P ❑Gas Other:___ Other: <br /> --- -- - ❑cu ft ❑Sewer: DATE: —i_RSDR#: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. H Normality* SAMPLE NO. CODE Anaunt Par nem Jl <br /> 3 <br /> FD(c CON l�1 Cn l�j /'I'/N 1 N 4 ` S C F,� L <br /> HW SHIP GOMPLT <br /> Mill 7 1 4 (JUL 0 8 <br /> ------- -- BY <br /> For RMMA Waste *Normality Required it pH a 2 or pH a 12.5 USE C NTIN ATION FORA1 FOR ADDITIONAL ITEAIS <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 iio,full rad analysis required) Generator Name(Pri Last,First): L-Code: Ext.: Inspected by HWM(Print Name-Last,First): Ext.: <br /> 2t.Was the waste exposed to particle ! �N 4 'e,75 i��� <br /> beams capable of inducing radioactivity SSiynatur gnal 1 <br /> Iby activation^ Yes[� No ❑ / <br /> Employee No.: Date Signature: Employee No.: Date: <br /> l_ 111 yes.full rad analysis required) 6����f //// <br /> ITEM RCM RCH P Origin Form EPA NO. DTSC NO. MSDS NO. Hazardous Properties Handling Code: By: <br /> Prefix Code Code <br /> T C 1 R <br /> — Date: Loc: <br /> Chemical Compatibility Code: <br /> ❑ ❑ ❑ De rtmgnt Generating Waste: <br /> gop <br /> ❑ ID ❑ ❑ HWM Requisition Appro 1:( Ignafare) <br /> — — --- -- ❑ ❑ LJ ❑ EmPioyae®2,-7,q Data: <br /> t.L 5344 B(Rev.3193) 7600-70502 (p/ <br /> Whito—HWM Copy <br />