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<br />EPA Form 5700-22A (Rev 3-05) Previous editlons are obsolete DESIGNATED FACILITY TO GENERATOR
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<br />UNIFORM HAZARDOUS WASTE MANIFEST
<br />-
<br />21. Generator ID Number
<br />22 Page
<br />I rormAPProved. UM6 No. 2050-0035
<br />23. ManifestTracking Number
<br />(ConUnuatlon Sheet)
<br />I CA2890090002
<br />2
<br />0058700"JLIK
<br />24 Generators Name LawTence LMRRttore NrI0n3i Labor -tory Stte 304 for NNSA
<br />P.O. Box am/ L -76B
<br />Wermore CAUM1 RECEIVE
<br />25 Transporter Company Neme US EPA ID Number
<br />JUL 14 2014
<br />26. Transporter Company Name US EPA ID Number
<br />27a 27b U.S DOT Descd*n (including Proper SN" Name, Hazard Class, ID.Number, 26. Containers -1k1Rjr-K1-rA1 HEA
<br />HM and Packing Group jdery?) No Type Quan29. tity wuvo EPARirIMONT
<br />5 NA3077, Huardousw3ste, sdFd, n.o.s. (0008), 9, III [ERG 1171]
<br />(DOPD105-1j
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<br />DQQr!
<br />2
<br />DF
<br />120
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<br />S. NA3077, Hazardous waste, solid, n.o.s. (DOGS), 9, III (ERG 171]
<br />(00P0038-1)
<br />ILSA
<br />pooO
<br />-
<br />2
<br />W
<br />150
<br />P
<br />7. NA3077, Hazardous waste, solid, n.o.s. (DOOR), 9, III (ERG 171]
<br />(C1OPO105-1)
<br />3111
<br />Due
<br />1
<br />DVS
<br />26 r
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<br />0
<br />8. NA3077, Hazardouswaste, solid, n.o s. (0011). 9, III [ERG 171]
<br />(DOPM36.1)
<br />s41
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<br />1
<br />Dr
<br />5
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<br />Doll
<br />9. NA3077, Hazardousmste, Solid, n.n.s (=B), 9, III (ERG 171]
<br />X-
<br />(DOPMOO-1)
<br />352
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<br />D"
<br />170
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<br />pole
<br />10. NA9082, Hazardous waste, liquid, n.o.s. (DOOR), 9, ill [ERG
<br />1711 (DOPD077-1)
<br />342
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<br />i
<br />DE
<br />256
<br />p
<br />Doae
<br />11. NA3082, Hn2rdous rasre, liquid, n.os. (0011), 9, III (ERG
<br />1711(DOP0096A-1)
<br />541
<br />4
<br />Dff3
<br />906
<br />P
<br />Dolt
<br />12. RQ, NA2212, Asbestos 9, Ill [ERG 171) (DOPD131-1)
<br />)sit
<br />1
<br />DY
<br />31
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<br />13. RQ, NA3082, Hazardouswrasre liquid, n o.s (DO11), 9, til (RQ
<br />`
<br />00 11) (ERG 1711(DOPGD98A-1)
<br />5
<br />DF
<br />980
<br />P
<br />541
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<br />Doli
<br />14 RQ, NA3082, Hazardous waste, liquid, n.o.s. (0011), 9, III (PC
<br />DO 11) (ERG 17 1) (DOPOO98A-i)
<br />3 D
<br />945
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<br />32 Special Handling Inst ucbens and Additions information
<br />33. Transporter__ArAnorAadgmenlof lofMaterials
<br />�1
<br />Prtnte&7yped Name Signature Month Day lean
<br />R
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<br />34 Transporter _Admowledgment of Receipt of Materials
<br />Printedlryped Name Slgneture Month Day Year
<br />35 Dtaaepancy
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<br />0
<br />I
<br />C
<br />36 Hazardous W
<br />P Management Method for hazardous waste trea and reWng systems) /
<br />HlqlH
<br />EPA Form 5700-22A (Rev 3-05) Previous editlons are obsolete DESIGNATED FACILITY TO GENERATOR
<br />TH
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