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Please print or type. (Form designed for use on e:lte (12-D jeyrdter.i <br />EPA Form 87M22A (Rev. 3-05) Previous edltiensare obsolete DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21 Generat;x ID Number <br />22 Page <br />v,n, r%F"Vva .v,r,o rvu. cuw-uo�� <br />23. Manifest Tracking Number <br />(Continuation Sheet) <br />CA2690090002 <br />3 <br />005870090JJ9 <br />24 Generators Name Laurence LP4ermom Mallanal laboratory Site NO for NN SA ���---aaa ,�°� <br />P.O. Boz 8081 L-786 <br />P VED <br />:IVem''re CA 44551 <br />5F1E <br />25 Transporter Company Name US EPA ID Number ', I y y O n <br />J V L i t r <br />JUL <br />26 Transporter Company Name US EPA ID Number <br />ENVIRONMENTAL HEALTH <br />27a <br />27b U.S DOT Description (including Proper SNpping Name, Hazard Class, IDNumber, <br />28 Containers29 <br />Total <br />30 Unit <br />HM <br />and Packing Gtnup (d any)) <br />Quantity <br />Wt Nol. <br />31 Waste Codes <br />No <br />Type <br />18. Non-RCRA haZ.3-douswaste, liquid (ant-1reezP) (DOP0810-1) <br />343 <br />3 <br />DU <br />895 <br />P <br />18. Non- RCRA hazardous waste, liquid (hydraulic fluid) (DOPO7?0- <br />zz3 <br />2 <br />DIF <br />79 <br />P <br />17. Non-RCRA hazardous waste liquid (sodium lame solution) <br />(DOP0088-1) <br />i <br />DF <br />629 <br />P <br />331 <br />-- <br />18. Non-RCRA hazardous w7rte, liquid (sodium lactate solution) <br />o <br />(DOPOOBE-1) <br />331 <br />1 <br />Dlf' <br />97 <br />I? <br />z-- <br />W 19 <br />Non-RCRA hazardous vraste, liquid (,spent oil) (DOP0.1"l-1) <br />x2s <br />5 <br />tai <br />1806 <br />$ <br />� <br />20,. Non-RCRA hazardous was'?, solid (bum pit ash) (S)95-2554} <br />1$i <br />I <br />DF <br />32 <br />P <br />21 Non-RCRA ha'7rdousrr3�-*.-, Solid (debris aontamnated rot <br />23 <br />petroleumhydrocatons', (00POO44-1) <br />1 <br />DF <br />qq <br />R <br />- <br />22 Non-RCRA hazardous waste, solid (debris contaminated w1t <br />2z, <br />petroleum h}c.r -:;rbons) (DOnD44-1) <br />2 <br />DZI <br />198 <br />P <br />- <br />Nen-RCRA hazardous solid (debris contaminatedwi!ti <br />lei <br />z:jffudc acid) (DOPOM& 1) <br />6 <br />Qts? <br />635 <br />P <br />) <br />24. Non-RCRA hazardouswaste solid (resin beads contan*nated <br />lei <br />with perchlorates) (DOP00.87-1) <br />5 TX. <br />1613 <br />P <br />_ <br />3< Special Handling Instructions and Addibonal Information <br />i <br />33 Tmrtspvter Acknm*d9ment of Rece pt of Materials <br />Fw— <br />Printed/Typed Name Signature Month Day Year <br />X- <br />- <br />O <br />0 <br />a <br />Z <br />34 TranspoAer AcknoWedgment of Recarpl of Materials <br />Printedlryped Name Sgnature W -nth Day Year <br />1-- <br />35 Discrepancy <br />J <br />U <br />Q <br />LL <br />Hazardous Waste Repo t Management Method Codes Q e., hazardous waste treatment, disposal and recycling systems) <br />ZZZazvLUa <br />F) <br />H1411 U&/ glql <br />EPA Form 87M22A (Rev. 3-05) Previous edltiensare obsolete DESIGNATED FACILITY TO GENERATOR <br />