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- H135774 <br /> LAWRENCE LIVERMC31� NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM Use Only Saye <br /> 1.Build �2. Ro m N 0 3. RMMA: 10.Hazardous Outer Container/Retention Tank 10: Overpack? scheduled waste Run Date: Void Requisition: <br /> (�` bE ❑ Yes No Pro erties: Elyse ElNo _7 1• �/ ❑DA-m:_ i / <br /> Toxic <br /> 4.WA 7*7 9440- <br /> 5. kpla a nd t 6.Account No' r t2.Outer Container t3.Outer Container Size: InitlalsiData <br /> /�+{Q/� ❑Corrosive ❑HWM Waste Run <br /> 112611 <br /> ,L�/ d --/.�,.�—/-_ _ '�a._ / Type: ❑ 1 gal ❑330 gal <br /> able ❑Box ❑ 5 gal ❑660 gal ❑ ite to LLNL RTO <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste. No 7.9 c� ❑ 7 gal ❑750 gal <br /> eactiver u Can Commercial Shipment WTO <br /> ❑Yes, Activity Codes(enter up to four): W W W W ❑30 gal ❑1000 gal <br /> 11.Waste Form: Fl Carboy El al EJ gal ❑Secured pickup <br /> Comments: g P <br /> El Solid ❑Drum 085 gal ❑1x1x1.5 It <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes o1:KLiquid �ank-Fixed ❑2x4x7 It ❑HWM Field Pump Out <br /> 8.Profile No: 9.Directorate: g ❑Tank-Portable ❑4x4x7 ft ❑ <br /> ( ❑Sludge gal HWM Generated Waste <br /> H p L� El Gas Other: Other: cu ft ❑Sewer: DATE-_/_f RSDR t3: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. H Normality' SAMPLE NO. CODE per item <br /> Anwun[ Un+ts <br /> -_r-93 N ezw u r.�a.�,s � sal. �L pow, r,4tiV, M6 IL 64L <br /> FRo TI�u g 7i ®v T <br /> Pj 6 s °ci <br /> AUG r <br /> For RMMA Waste *Normality Required if pHs 2 or pH z 12.5 USE CONTI UATION 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 ❑ -- <br /> (if no,full rad analysis required) Ge for Name�(?Pr�int—Last,First): �� L-C`odle: Ext.: inspected by HWM Print Name—Last,First): Ext.: <br /> 21.Was the waste exposed to particle �>�.( /� /T ✓� avl�e `✓ <br /> beams capable of inducing radioactivity —� Employee No.: Date: Signature: Em to ee No.: Date: <br /> Signatur9 P Y <br /> by activation? Yes❑ No ❑ q ?Q ']_/C�} <br /> j (If yes,full rad analysis required) 0!3 J C� J 1 <br /> RCH RCH P EPA NO. DTSC NO. MSDS NO. Hazardous Properties <br /> Handling Code: By: <br /> ITEM Origin Form Pe <br /> Prefix Code Code <br /> T C I R <br /> Date: Loc: <br /> �'c 2r( 2 ( 'j o ❑ ❑ j <br /> ❑ ❑ ❑ Chemical Compatibifity Code: 1 <br /> ❑ ❑ ❑ ❑ Department Genera' g Waste: 7/ <br /> I--] F-1 El ❑ HWM Requisite Approval (Si' tore) <br /> ❑ ❑ ❑ ❑ Empl No.: Date: <br /> LL 5344-B(Rev.3/93) 7600-70302 <br /> White—HWM Copy <br />