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<br />RECEIVED
<br />EPA Form 8700-22A (Rev. 3.05) Previous editions are obsolete I DESIGNATED FACILITY TO GENERATOR
<br />I , - --
<br />UNIFORM HAZARDOUS WASTE MANIFEST Generator ID Number
<br />22 Page
<br />rorITIAPProvea. UMd No. 2050-0039
<br />23. ManitastTrackIng Nn
<br />121
<br />(Con8nuatlonSheet) GU690t190002
<br />4 %
<br />$SJIJ�,��$, 20 14
<br />JJK
<br />24 Generators Name LMrOnce Livermore NatlonaE Labarstory S#e
<br />P.O. 60x90$ L-786 ENVIRONMENTAL HEALTH
<br />L1Yermore CA 94571 DEPARTMENT
<br />25 Transporter Company Name US EPA ID Number
<br />26 Transporter _ Corrpany Name US EPA ID Number
<br />27a
<br />27b U S DOT Desalption (including Proper SNpphg Name. Hazard Class, ID Number,
<br />28. Containers
<br />19#
<br />30.
<br />HM
<br />and Packing Group (d any)) -
<br />ouanbt
<br />1Y!Vd
<br />31. Waste Codes
<br />No.
<br />Type
<br />25. NA3077, Hazardous waste, solid, n.o s. (D0081. 9 III [ERG 171]
<br />(DOP0113-1)
<br />lel
<br />--
<br />D008
<br />-- —
<br />1
<br />DF
<br />s
<br />p
<br />26. NA3077, Hazardous wa"^e ^olid, n o s (0008), 9, II► [ERG 171]
<br />(DOP00w-1)
<br />:1
<br />DVI
<br />99
<br />P
<br />0008
<br />27. NA3077, Ha73rdouswaste solid, n.o.s.1D040), 9, III (ERG 1711
<br />(DOP0032-1)
<br />asl
<br />V43
<br />1017
<br />k
<br />Doan
<br />i
<br />0
<br />28 NA3077, Hazardous waste, solid, n.o s (D440), t III [ERG 17 1)
<br />-
<br />(DOP0036-1)
<br />w
<br />2
<br />It13
<br />614
<br />4
<br />04410
<br />0
<br />29 NA3077, Hazardous waste solid, n o s , 9, III (Lab Pack) [ERG
<br />17 11 (DOP0113-1)
<br />y�l
<br />1
<br />IIF
<br />ii
<br />P
<br />Dans
<br />30. NA3082, Haza-douswasie liquid, In o s. (D011), 9, III [ERG
<br />1711 (DOP0098A-1)
<br />sai
<br />4
<br />M
<br />1245
<br />r
<br />Doli
<br />31 RQ, NA.2212, Asbestos, 9, III (r --R(3 1711(DOP0131-1)
<br />151 i
<br />2
<br />DF
<br />26
<br />P
<br />32. RQ. NA2212, Asbestos, 9, III jERG 171-L(DOP4i31-1)
<br />1
<br />pd4
<br />??
<br />@
<br />33. RQ, NA3077, Hazardous waste, solid n.o s (13008), 9, III (ERG
<br />1711 (DOP003&i)F
<br />lsl
<br />2 trti
<br />t fi
<br />F
<br />DOOR
<br />34. RQ, NA3082, Hazardous waste liquid, n o.s. (D011), 9, III (RQ
<br />(3011) [ERG 1711!7)OP0096P-1)
<br />1 [x3
<br />549
<br />sal _
<br />Da ri
<br />32 Specht Handlag Instructans and Addbonai Inbarimn
<br />33 Transporter _ Acknowledgment of Receipt of Matedah
<br />Printed/ Typed Name Signahire Month Day Year
<br />4O.
<br />N
<br />34 TransporterAdrroa_ mentofReceipt ofMatenais
<br />Pnnted(Typed Name Signature Month Day Year
<br />H
<br />35 Discrepancy
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<br />V
<br />LL
<br />O
<br />36 Hazardous Waste Report Management Mettmd Codes Cie., "for rArs waste treabrrent, d sposel a systems)
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<br />Lracydng
<br />14 ILIZ �'
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<br />EPA Form 8700-22A (Rev. 3.05) Previous editions are obsolete I DESIGNATED FACILITY TO GENERATOR
<br />
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