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H177 <br /> LAWRENCE LIVERMCGr,c NATIONAL LABORAi-OHY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION <br /> I IAuI I i 2 Ruor�i No t 3 HMMA 10 Hrrtdrduus Outer Container/Retention Tank ID: Overpack? scheduled Waste Run Data: Void Requisition: <br /> ��Ji�{y. /�rr1�,, �'�"' p/� <br /> V,7 �/!`/51��� I ) Yes rJi. I'roperties ( )res FINo / ,�® / /Z [ )DATE. <br /> .._._ .._ .------ -- - -- --- Muir _._.-- - -- <br /> .1 WRQ No. / 5 Vyjykplaee�jld�t 6 Account No -7 - 12 cn,r�i CumlauIor 1:1 a h.,i-,nd u....r bira L) InitialsMato...- -- <br /> [(�� [tj `[// {I//+,�dCC f .� S�✓G. ! HWM Waste Run <br /> [ Cu si a TYPe (_ J 1 gal ( )330 gal /4§ <br /> / Wasto Minimization Efforts Practiced During Generation of this Waste? vii" I )Box I ) ,> 9ar1 ( )660 gal r1 Off-Site to LLNL RTO Q <br /> I )R�acTvc L_J Can [_) 7 gai ).)750 gal �� <br /> )'res. Activity Codes(enter up to four): W W W W 1 1000 11 a�Commercial Shipment WTO <br /> 1 i Waste Form [_ )30 qal 9< <br /> I Carboy r <br /> I _155 gagal l 1 1 X000 gai F-1 Secured Pickup <br /> nI <br /> [.]Dan 185 I. )1x1.15 it <br /> �f <br /> DOthisWaste Minimization etlun Degin ill current calendar years ElVes -_ J�No •Ligindank-Fixed I J 2.4x7 it IJHWM Field Pump Out <br /> 8 Profile No: 9.Directorate f��" [A Sludge Tank-Portable [-)4x4x7 it 9 �g31 ❑HWM Generated Waste <br /> H_ P ---- [ 1 Gas Other Other "�® <br /> - J C7 cu it ❑Sewer: DATE:_J___!__RSDR Y: <br /> 14,ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19 QUANTITY <br /> NO. SAMPLE NO. CODE I-' , <br /> H Normality .� ,..,� uun, <br /> w� tAN Ns�DS,9L_- L 01, Irak uP <br /> F Owl <br /> CO PL <br /> - <br /> - G q®r ------ --- AUG 10 <br /> BY <br /> For RMMA Waste "Normality Required of pH 2 or pH z 12!3 _ _ __ USE C_C>N 11N1t-111(iN Fc)NAl Fi�H 1Li�l1iUNAt 11 Fh1i <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 inturmalion provided on this reyulsitwn is collect I understand that I may be liable to Stale and Fedowl pr,,,ccuUon by intenhun,iuy <br /> (using a glove box,vent hood,etc.)? providing false information. <br /> YesO No❑ ------_----._.___-_ <br /> Ill i full rad analysis required) Generator Name(Print-Last.Firsts). . LL-jCode: Exl, Inspected by HW Print Name Lasl,Rrs Ext. <br /> z i W-tire waste exposed to particle PFZ � S 1�4n; ZJ,3 S <br /> bu,inls capable of inducing radioactivity ---" -__---- <br /> Siyiiature: Employee No Date Signature: Employee No Date: <br /> by achvallon"? Yes[-] No[_1 j <br /> til yus full tad analysis required) 42K 7 <br /> 13 <br /> ITEM RCM RCH P Origin Form EPA NO. Handling Code: By; <br /> Prefix 9 DISC NO. MSDS NO. Hazardous Properties <br /> Code Code <br /> T C I R _ - - <br /> --- --- Date: Loc: <br /> Chemical Compatibility ode: <br /> Department Generating Waste: 9 7 j <br /> HW Requtaitton Approva Si ature) <br /> -- — ._ .— le <br /> - — - <br /> Emplisyllis No.: <br /> 11 5344 8(Rev.3193) 7600-70302 -- _ --- <br /> White—HWM Copy <br />