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"-=�•�•�"��"v--cnvlronmC.nto�'rro/ec,,on Ngency Form Aprroved••6M8 No.7. b-0039(Expires 9-30.94) -See Instructions on back O Please pn.A or type. form designed for use on elite(12pitc writer. 9e 6- Department of Toxic Substances Contr Generator's US EPA ID No. Sacramento,California UNIFORM HAZARDOUS Manifest Document o. 2. Page 1 Information in the shaded areas WASTE MANIFEST I i I I I I is not required by Federal low. 3. Generator's Nam®and Mailing Address of� . .ti t.owrence Liv+a in Natl=ai tory, Site 300 r--: cV PO BOX 808. L-820, Lfmnrlom, CA 84551 � � � K+•+-.�.. M 4. Generator's Phone C? _ 0 5. Transporter 1 Company Names t; 6. US EPA ID Numberco C yrs EveMreen Enviionmental Services i rx0111 �i J _ T t•7 its.. -" 7. Transporter 2 Company Name 8. US EPA ID Number UStaTerauttpotte`r's 9. Designated Facility Name and Site Address �010. US EPA ID Nvmber G, sjop,�sry"a s 3a Evergreen 00.Inc e � � 6�13�8O Snttlh Avenue rR fRlY r..�A 94560 H t hty"S rrryrrC '1rsM Kv f� �y,-uJ g� - `�U C A D 9 8 Q 8 8 7 4 1118 c 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Nvmberl 12. Containers 13, Total 14 Unit r z• No. T Quantity Wt/Vol 1 Waste Number:��. i G aState r r`- c-OrTTbustible Liatt:d n.O.S.,NA1993, III oi E (diesel;see!) 00 co b. 01011 T TQ 15 " G EPA/other E Sraro, , p IR A EPA/Other o. T C. y O .State. r ,r R F i EPA/Other,' Z I d. I I w I I U State w t . V) I EP A/Others i OJ. Additional Descriptions for A4aferwls LListid Above` t ¢ " x �t A -"' � i pg do sty K afattdratg Codes,. or aster,Listed Above �' �1•si W i&R� it ~T. i �RAA f �'rp 't''t''<* <.t' N i k" ¢ e%e "r*3'" ® n'�• ham, ppp _ a t,r. aFP`• t�x�� ^-c J i•�«t,w'�+L��/�` '.�. 1•SyP.I�� iid<� �ff a�e,r�.�Jla !�. c � �,ti. �.� r s�"".' Z :« - .a' 1srt .SY'.rcc^•a tr-fya ''t .' t ,..c� s.¢ t-�rri gt^� ` 0 15. Special Handling Instructions and Additional Information Z Wear Protec a Clothing When Handling.* andlingEMERGENCY CONTACT: M.N. Hayes, (510) 447-6880 u,I LLNL ShipDoc Number. S- Reference Release Number IWY OS'r�a on the invoice. i These materials are NOT radioactively contaminated. J ( 16 GENERATORS CERTIFICATION I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, VI packed,marked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable federal,state and international laws. 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 1 have determined to be CL economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future V) I threat to human health and the environment;OR,if 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best ce waste management method that is available to me and that I can afford. 0 Printed/Typed Name i Signature Month Day Year UR ima rd a I=enLLJ Z 1 r 17. Transporter 1 Acknowled ement of Receipt of Materials tf 1 A Printed/Typed Name Signature I`" Month Day yYear 0 1 Transporter 2 Acknowled ement of Receipt of Materials i t� ` W R O I a Printed/Typed Name Signature Month Day fear I LU i 19. Discrepancy Indication Space 1 U F A I C =) 1 I L it 20. Facility Owner noreceto hazardous materials covered b this manifest exc d in hem 19. T Printed/Typed Name Signature Y �•••�• - Momm Dov � Year DO NOT WRITE BELO. THIS LINE..-'- DTSC 8022A (12/91) - -_')°y i°Y EPA E70G-22 -0 sub, 107. c�rroo�,s was sTrOe Dfovr sIToHn:po o t-otcT- stae, c0mnlete PY ct :•5 :JDy Cn0 sena to .,.S: ti.....in 30 dais.;