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Please print or lupe (Form desioned for use on At <br />EPA Form 87DG-22A (Rev 3-05) Previous eft6ns are obsolete DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />,, � <br />21 Generator ID Nu <br />22 Page <br />r m 8PPfjV@9rf4rAJJ No.LUbU-W39 <br />23. Manliest Tracking Num <br />(Continuation Sheet) <br />t <br />1 CA2890690002 <br />5 <br />00586WILI JJK <br />24 Generator's Name lArsrence Ltvermare INIVIln3! Laboratory Stte Kn ENVIRONMENTAL HEALTH <br />P.O Box wo L-715 <br />Livermore CA94Rg1 DEPARTMENT <br />25 Transporter _ Company Name US EPA ID Number <br />26 Transporter _ Company Name US EPA ID Number <br />27a <br />27b U S DOT Description (mduding Proper Shipping Name, Hazard Class, to Number, <br />28. Contalners <br />29 Total <br />30 U it <br />HM <br />and Packing Group (d awry)) <br />Quantity <br />Wt o' <br />-31 Waste Codes <br />No <br />Type <br />35 RQ, NA3082, Hazard-usliquid, n o s (DO 11) 9, IU [FIRG <br />-1t71] <br />(DOP009t3,1-1) <br />DO <br />_ <br />nou <br />< <br />sss <br />P <br />36 Nan-RCRA hazardouswa!7!e liquid (Trich'oro!ri?iuoro? ane, <br />741 <br />Propylene Glycol) (DOP0120-1) <br />1 <br />Or <br />1.30--- <br />37. Non-RCRA hazardousri3ste bgirid (=n�ronlurnthiosPe and <br />potasvum sulfite) (OOP0120-1) <br />1 <br />DF <br />33 <br />P <br />0 <br />38 Non-RCPA hazardouswast-? liquid and <br />rrhrmixture)(DOP001G-1) <br />2.12 <br />w <br />1 <br />VIM <br />395 <br />P <br />cwa <br />39 Non-RCRA hazardous vr�, liquid fired ail) (DOP0080-1) <br />221 <br />13 <br />Im <br />4555 <br />P <br />40. Norl-RCIRA haves dousr,-ae, liquid (v%--rer contarrl,n7!zd Pith <br />134 <br />1 <br />petroleum hydrocarbons) (DOPG010-1) <br />1 <br />ut�T <br />236 <br />P <br />41 N orr RCFZA hazardous wage, liquid (vv -iter cantaminated w^ <br />petroleum hydrocatons) (DQP0010-1) <br />i <br />M1 <br />423 <br />P <br />222 <br />42. Non-RCRA hazardoQs ware, gond (E.oMRin�tl -01sil-ozne). <br />_ <br />i <br />l <br />(DOP0120-1) <br />IIF <br />19 <br />131 <br />i <br />43 Non-RCP.A hazardous waste solid (absorbent, dirt <br />I <br />1x?�minated �^.-i7petroleum hydrocart�ons) (DOFG 1 G4-1) <br />1 <br />aV <br />41 <br />F, <br />z=' <br />44 NorrP.CRA hazardous waw, solid (calcium ssuffate) <br />(DOP012G-1; <br />Y/7 <br />1 Iif7 <br />295 <br />P <br />32 Spedal Handling Instrucbons andAddliona Vformation <br />33 Transporter Ackno-M ment of Recept of Materials <br />PrinWirryped Name Signature Month Day Year <br />O <br />a <br />Z34 <br />Transporter Acknowl!dqtnent of RecW of Materials <br />Printedfryped Name Signature Month Day Year <br />t— <br />35 Discrepancy <br />_J <br />V <br />Q <br />LL <br />D <br />2 <br />36 Hazardous W_ �!e Report Yanagement Method Codes P a, cadets for�hazardeus waste treatment,nd angsystemc) I I <br />�'i�-J <br />J11 `T <br />I <br />W <br />LU <br />141 IiI� <br />�`f i I�-� I �� 1�► <br />EPA Form 87DG-22A (Rev 3-05) Previous eft6ns are obsolete DESIGNATED FACILITY TO GENERATOR <br />