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X135755 <br /> LAWRENCE LIVERMOnE NATIONAL LABORATORY ACCEPTABLE FO-- - 693 <br /> HAZARDWASTE DISPOSAL REQUISITION ❑ HWM Use Only Page—L—of J - <br /> 1.Bui/id��g No: 2. Room o: 3. RMMA: 10.Hazardous Outer Container/Retention Tank ID: Overpack? scheduled Wasu n oab: Vold Requisition: <br /> ❑ Yes No Properties: []Yes ❑Noy / <br /> ❑DATE:�� <br /> 4.WAA _ 5.W lac nd 6.Accou N Toxic <br /> • P 12.Outer Container 13.Outer Container Size: C1 HWM Waste Run Inkiats7Date <br /> -- /---/- -- - _ i ❑Corrosive TYPe <br /> �- _'_ ❑ 1 gal ❑330 gal <br /> 7.Waste Minimization Efforts Practiced During eneration of this Waste? No ❑Box ❑ 5 gal ❑660 gal ❑OH-Site to LLNL RTO <br /> ❑ E3 Reactive Yes, Activity Codes(enter up to four): W___ W W W ❑Can l `-'vommerc <br /> ❑30 gal ❑1000 gaial Shipment VSO <br /> 11.Waste Form: C3 Carboy E35000 al <br /> Comments: ❑55 gal g E]Secured Pickup <br /> ❑Solid ❑Drum ❑85 gal ❑1x1x1.5 it <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes o Liquid 15STank-Fixed ❑2x4x7 it ❑HWM Field Pump Out <br /> ❑ <br /> 8.Profile No: 9.Directorate: Sludge ❑Tank-Portable 4x4x7 it 13 HWM Generated Waste <br /> ---- El Other. Other: 3cx) Agal <br /> ❑cu ft E3 SSewer: DATE:_/_1 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 nem <br /> Amoum UMIe <br /> A-56e C c�S`L� D(r s E Fuk� L �� U-PL <br /> FL&s Pa/Al-r i 7 is <br /> COMPLETE <br /> UUN 24 <br /> For RMMA Waste *Normality Required if pH s 2 or pH a 12.5 USE CONTIt-kATIO0 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 Imay be liable to State and Federal prosecution by intentionally <br /> (using a glove box,vent hood,etc.)? providing false information. <br /> Yes C:1 No❑ <br /> (If no;full rad analysis required) Generator Name(P' Last,First): L-Code: Ext.: Inspected by HWM(Print Name-Last,First): Ext.: <br /> 21.Was the waste exposed to particle t'7 f t `tom' /� Q 35, <br /> ;Kir)' <br /> capable of inducing radioactivity Signature: Employee No.: Date: Si nat Employee No.: Date: <br /> by activation? Yes❑ No❑ c <br /> (if yes,full rad analysisrequired) <br /> ITEM RCH RCH P Origin Form EPA NO. DTSC NO. MSDS NO. Hazardous Properties Handling Code: By: r <br /> Prefix Code Code <br /> T C I R <br /> �g Date: Loc: <br /> O ❑ ❑ ❑ Chemical Compatibility Code: <br /> /G„ <br /> ❑ ❑ ❑ ❑ Department notating Waste: <br /> r <br /> F-1 El F-1 ❑ WM Requis on pproval: g tura) <br /> Emp��y_es <br /> . ❑ ❑ ❑ ❑ l No.: Date: <br /> i/D Z <br /> LL 5344-B(Rev.3/93) 7600-70302 <br /> White—HWM Copy <br />