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Please print or tvoe. (Form desioned for use on mita M7_n..._.. nrnimmiinrl <br />EPA Form 8700.22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />, <br />TH <br />- <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number <br />CA2890090002 <br />22. Page <br />4 <br />I Wil r44AUVUU. VIVID IVU. LUW-WatJ <br />23. Manlfvst Tracking Number j <br />Oa <br />AZW <br />24. Generators Name Lawrence Uvermofe Natlonat L!!+orator7 Sae VD for NNSA <br />P.O. Box 808 t L-7136 <br />t.)ve more CA 44551 <br />25 Transporter Company Name U.S. EPA ID Number JUL 14 ZU14 <br />26. Transporter Company Name US EPA ID Numbe <br />ENVIRONMENTAL HEA <br />27a <br />HM <br />27b, U.S DOT Descd*n (IndudIng Proper SMpping Narge, Hazard ClassJD.Number, . <br />and Pecking droop (H any)) <br />26. Containers <br />29. Total <br />Quantity <br />30. Un <br />WtJVol. <br />31. Waste CodesNo. <br />Type <br />25. Non-RCRA hazardous waste, solid (silica Ael) (DOP0085.1) <br />1 <br />DF <br />43 <br />P <br />lttl <br />— <br />-- <br />28. Non-RCRA hazardous waste, solid (soil contaminated with <br />penleum hydrocarbons) (DOPO104-1 ) <br />1 <br />DH <br />oris <br />P <br />223 <br />-- <br />27. Non-RCRA hazardous waste, solid (spent carbon) (DOPOW5- <br />1) <br />i5 <br />DO <br />4872 <br />P <br />181 <br />— <br />— — <br />oc <br />0 <br />t— <br />z <br />w <br />3• <br />i <br />32 Special Handing Instructions and Add tions' Information <br />c <br />33 Transporter AdmaMedgment of Receipt of Materials <br />a <br />PnntWTyped Name Signature Month Day Year <br />z <br />34 Transporter meet of Receipt of Materials <br />F <br />FYntedfTyped Name Signature Month Day Year <br />J <br />V <br />Q <br />LL <br />� <br />ul <br />35 Discrepancy <br />a <br />ra <br />4yaste Management Metod Codes 1 ., hazardous waste t ,r4 nd qdN systems) <br />qqq <br />ut <br />0 <br />EPA Form 8700.22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />, <br />TH <br />