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H135764 ACCEPTABLE Frl 693 <br /> LAWRENCE LIVERMOrtc NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION _❑ HWM Use Only Page , of L <br /> 1.Buil /N�o: 2. Room 3. RMMA: 10.Hazardous Outer Container/Retention Tank ID: Overpack? Scheduled waste nun onto: Vold Requisition: <br /> �C ® <br /> El Yes No Pr erties: Ely" ❑No 4/ / _J ❑DATE: ) / <br /> Toxic <br /> 4,WA O: 5.W rkplac End Pa 6.Account o' rL 12.Outer Container 13.Outer Container Size: te <br /> / - 3 = --f Corrosive ❑HWM Waste Run <br /> /- / Type ❑ 1 gal ❑330 gal • <br /> (AA7/9 el <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? (�io �,� <br /> ❑ Ignitable ❑Box ❑ 5 gal ❑660 gal ❑Off-Site to LLNL RTO <br /> ❑ Reactive ❑Can ❑ 7 gal ❑750 gni L 7Commerclal Shipment <br /> ❑Yes, Activity Codes(enter up to four): W___ WWW_ ❑30 gal ❑1000 galWTO <br /> 11.Waste Form: ❑Carboy ❑5000 al <br /> Comments: 1-155 gal 9 ❑Secured Pickup <br /> Solid ❑Drum ❑85al F11x1x1.5 it <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes No El Liquid Tank-Fixed g ❑2x4x7 ft ❑HWM Field Pump Out <br /> 8.Profile No: 9.Directorate: `T� ❑Sludge <br /> ❑Tank-Portable ❑4x4x7 ft ®HWM Generated Waste <br /> 1 ❑Gas Other: Other.. gal <br /> H P ❑cu It 10Sewer: DATE:_1_J RSDR/: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. * SAMPLE NO. CODE per hem <br /> H Normality* Amount urvts <br /> A s a a►�K q►an Assoc A p NC 01'21 4i J 1< kADC1 eAck <br /> CC t J rl�EDD1 L '! 1.�-ZL <br /> HWM SHIP INO • <br /> JuIN 7 11,94 <br /> MUL <br /> For RMMA Waste *Normality Required if pHs 2 or pH a 12.5 USEC0N9W=dR= 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 Inlay 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) Genera r Name(Print,-Last,First): L-Code: Ext.: Inspected b Print Name-Last,First): Ext.: <br /> 21.Was the waste exposed to particle I 1 c� L 7S S <br /> beams capable of inducing radioactivity Signature: p Employee No.: D t Signature: Employee No.: Date: <br /> by activation? Yes E) No❑ <br /> (11 yes,full rad analysis required) L -� Q� 7�-7 3 - [7 <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 /> v 5 r ® ❑ ❑ ❑ <br /> ❑ ❑ ❑ Chemical Compatibility Code: <br /> ❑ El ❑ ElD of"ZbttrentGenerating Waste: <br /> 300 ' <br /> ❑ El El ElHWM Requisition Approval:(j/grata <br /> W' <br /> Employee No.: Date <br /> ❑ ❑ ❑ ❑ <br /> LL 5344-B(Rev.3/93) 7600-70302 <br /> White—HM Copy <br />