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H135771 <br /> LAWRENCE LIVERMOviE NATIONAL LABORA101iY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION t <br /> I Hoilduiy No 2. Room No 3. RMMA 10 Hazardous Outer Contalner/Retentlon Tank ID: Overpack? Schun sdul.d wssrs RbNe: Void Requisition: <br /> Yes No Pru�erties I(� n <br /> _ I es No 7 /-F7 / 7,9"' 1 1 DATE: ! / <br /> Tu>tic -----...----- --_._ 111---- ---- - --------- - -_.. <br /> 4 Wp;,� 5.V7kpiac Fwd f9e 6.Account No: _ _ rz Outer C.olwtiei t f o t,c•��em�e:r Sin, <br /> wtl _l7 /._/ 5 j 3 s-6. 7 t L.�coo-we <br /> Type L-)HWM Waste Run _. ..InlllalalDa <br /> ---- ( 1 )a1 1 1330 gal <br /> / Waste Minimization Efforts Practiced Dunng Generation of this Waste'? ifrin, 1 1 Igi,t,ible ) )Box ( I 5 qa 1 )660 gal 2., <br /> -Site to LLNL RTO <br /> r� <br /> [_1 Reactive [_1 Can L 1 7 ya1 ( 1750 gal <br /> I )Ycs. Activity Codes(enter up to tour): W W W W [ ),Fu (I it ( 11000 gal mercial Shipment gyro �� <br /> I IWaaste Form ( )Carboy <br /> i '[ )Isola d Drum Fixed 1 155 gal L]2x4x17 5 gal L I Secured Pickup <br /> s .......... -- —- <br /> 1_)t35 al <br /> it <br /> Old ilis Waste Minimization effort begun in current calendar year? ❑Yes I]e�1u y L�HWM Field Pump Out <br /> - - --- - — --- -_ �- L�4x4x7 It <br /> t3 Profile No: 9.Directorate t L.) Sludge Tank-Portable <br /> g A�1gal HWM Generated Waste <br /> H_ P__—.-- L 1 L Gas Other 011ie, - <br /> _._ - / L7 Cu If ❑Sewer: DATE: / ! RSDR Y: <br /> 14 ITEM 15.AQUEOUS OMLY 16.ANALYSIS 17.SOURCE 18 CHEMICAL/PHYSICAL DESCRIPTION 19 QUANTITY <br /> NO. SAMPLE NO. CODE I., ir„ <br /> pH_____ -- Normality A,-,, -- - `i-1 <br /> _ ---- - `t' � A+.7 f� t SSO C t �❑D ,!7ri 1r�On� AN k �i4c��__ COO -- <br /> rill s_3#_DluL--- -- — - ---- - _ - -- - --- <br /> For RMMA Waste 'Normality Required d pH 2 or pH z 11 S USf: lit AIS <br /> JO Was the waste kept isolated from <br /> any operatiun 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 Slate and Federal piosecuuun by nudnbonauy <br /> (using a glove box,vent hood,etc.)? providing false information. <br /> Yes Ll No [:1 <br /> (It no tidl rad analysis required) Generator Name Print-Last,First <br /> y� � q ) ( � 1 L-Code: Ext* <br /> inspected by HWM jPnnt Name-Last,First): Ext <br /> 1 Was the waste exposed to particle <br /> b�:.inns capable of mducipy radioactivity --------- ----------_}.._ _____.--- - -- - - .-_- -- _-_..-- ----- ---- ----- --- -.----- <br /> Si nature: Employee No. Date: <br /> by a.Irv.uh,n? Yes❑ No❑ g •• gnature: 1ployee No: Date: <br /> 00(It y•; lull lad•ulafysis reyuued) 3738 7/5 C. <br /> 71,_- - - -- ! 1, <br /> ITEM RCH RCM P Origin Form EPA NO. DTSC NO. MSDS NO. Hazard oU Properties Handling Code: By: <br /> Prefix Code Code <br /> T C 1 R --- <br /> Date: <br /> -Date: Loc: <br /> l Chemical Compatibility Code: <br /> 1 1 <br /> Department Generatin Waste: <br /> n- F1F1r HWM Requisition proven:(Signe r'a <br /> Empla No.: Date: <br /> LL 5344 13(Rev.3/93) 7600-70302 White--HWAACopy <br />