Laserfiche WebLink
}ate of Califomao-- i Protection Agency o a <br /> 8 No.2050-0039(Expires 9.30.94) See Instructions on back ge 6. Department of Toxic Substances Control <br /> se print or type. form designed for use on elite(12-pitch)typewriter. <br /> Sacramento,California <br /> Generator's US EPA ID No. Manifest Document NPage I Information in the shaded oreas <br /> UNIFORM HAZARDOUS is not ro. 1 2. uired b Federal law. <br /> ? WASTE MANIFEST I p 9 0 01910101012 9 41 2 2 2 of 'I <br /> y j <br /> 3. Generator's Name and Mailing Address <br /> oe Lire National Laboratory, Site 300vemwra <br /> PO Box 808, L-820, U ,CAO 94551 <br /> to . - _ <br /> ac,n 4. Generator's Phone (510) 422-1925 ' Attn:Arlene Wilt, L-620 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number <br /> Evergreen Environmental Services <br /> CAD98106957161 <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number <br /> U <br /> �q z 4. Designotecf F c Name and Site Address 10. US EPA ID Number <br /> ♦® Evergreen(hl <br /> O 6880 Smith Avenue ; <br /> J Newerk,CA 945%0 <br /> ,a C A D, 918, 0 818, 714 1 8 <br /> . <br /> .V Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12Containers 13. Total 14. Unit <br /> No. T e Quantity Wt/Vol <br /> V`= Combusbble Liquid n.o.s.,NA1993, 111 4 97St <br /> 77 E I (diesel fuel) 0 0, 1 T�T 0, G <br /> 00 N b. <br /> C9 E04 R <br /> i <br /> A ', r <br /> o T l C. f <br /> °° p I <br /> R <br /> Uj <br /> Z d. <br /> W <br /> V <br /> LU <br /> Vf <br /> Z <br /> 0 <br /> CL <br /> V) <br /> W <br /> rr <br /> Q <br /> Z <br /> 0 Handl' <br /> dear�mtec vetr�`�at> pIng`ohen Hai>dl ng. EMERGENCY CONTACT: M.N. Ha 510 447-W80 <br /> Z LLNL ShipDoc Number S- 8 Reference Release Number IWY- �on the invoice. <br /> W These materials are NOT radioactively contaminated. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marker, and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> 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 l have determined to be <br /> CL economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> V) threat to human health and the environment;OR, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> 0 Printed/Ty ed Name Signature Month DYear <br /> Day} Richar�B. Loden on behalf of LLNL ® p <br /> U r r <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> UW, A Printed/Typed Nome <br /> `_' SignaNr Month Day Year <br /> tLu PY s F� k lc. ry <br /> Wa 18. Transporter 2 Acknowled ement of Receipt of Materials <br /> T Printed/Typed Nome Signature <br /> aL t 9 month Day Year <br /> 0 R <br /> W 19. Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z C b <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> Y ( Printed/Typed Name Signature Month •aa epi <br /> i <br /> DO NOT WRITE BELO <br /> LINE.-- <br /> .7 <br /> r <br /> y.• t 1spYd .r Wn <br /> Yelbwtvt TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 -S <br /> DTSC 8022A (7j92) K n a t ' ♦ s {+ N, <br /> .1 <br /> who submit hazardous waste for 4rWtsporl ?' <br /> EPA 8700-22 5 4 a;14 s. ,}�u.}t#sF }jAr. uce completed copy of this copy and send to;.DTS <br />