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Please print or type. (Form deslqned for use on elite (12 -pitch) typewriter.) <br />Form ADDroved. OMB No. 20500039 <br />EPA Form 8700-22A (Rev. 3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21. Generator ID Number <br />22. Page <br />23. Manifest Tracking Number <br />(ContInuatlon Sheet) <br />CA2890090002 <br />6 <br />005870331 <br />JJK <br />24. Generators Name Lawrence Livermore National Laboratory Site 300 for NNSA <br />P.O. Box 808 / L-786 <br />Livermore CA 94551 <br />P,e <br />25. Transporter Company Name <br />U.S. EPA 10 Numtjr I <br />, <br />26. Transporter Company Name <br />U.S. EPA 10 Number <br />J <br />27a. <br />27b. U.S. OCT Description (Including Proper Shipping Name, Hazard Class, ID Number, <br />28, Containers <br />29, Total <br />30. Unit <br />EN EN I AL <br />�ttT1�/IE <br />No. <br />Type <br />HM <br />and PackingGroup(dany)) <br />Quantity <br />WW <br />45. Non-RCRA hazardous waste, solid (grease, sealant) <br />rnnPOl2Q-1) <br />1 <br />OF <br />io <br />P <br />337. <br />48. Non-RCRA hazardous waste, solid (non PCB capacitors) <br />(DOP0028-1) <br />1 <br />DF <br />26 <br />P <br />223 <br />47. Non-RCRA hazardous waste, solid (non-PC8 capacitors) <br />(DOP00:9-1) <br />3 <br />OF <br />95 <br />e <br />223 <br />0 <br />48. Non-RCRA hazardous waste, solid (non -PCB capacitors) <br />22; <br />.- <br />(00P0029-11) <br />i <br />DH <br />243 <br />e <br />w <br />z <br />49. Nan-RCRA hazardous waste, solid (rags contaminated with <br />petroleum hydrocarbons) (DOP0044-1) <br />1 <br />DM <br />175 <br />P <br />223 <br />50. Non-RCRA hazardous waste, solid (rags contaminated evith <br />petroleurn hydrocarbons) (DOP0044-1) <br />1 <br />DM <br />137 <br />P <br />223 <br />51. Non-RCRA hazardous waste, solid (soil contaminated with <br />223 <br />petroleum hydrocarbons) (DOP0104-1) <br />1 <br />UK <br />198 <br />P <br />52. Non-RCRA hazardous waste, solid (used fuel filters) <br />223 <br />(DOP0044-1) <br />i <br />OF <br />16 <br />P <br />53. Non-RCRA hazardous waste, solid (used oil filters) (00P0044- <br />223 <br />! ) <br />1 <br />OF <br />33 <br />P <br />54. Non-RCRA hazardous waste, solid (used oil filters) (DOP0044- <br />223 <br />1) <br />1 <br />DF <br />6 <br />P <br />32 Special Handling Instruct ons and Additlonal Information <br />33. Transporter AcknoVedgrnent of Receipt of Materials <br />j <br />Pdnted/ryped Name Signature <br />Month Day Year <br />W <br />O <br />a <br />rn <br />34. Transporter Admowied meet of Rece t of Mated& <br />Printed/ryped Name Signature <br />Month Day Year <br />t-- <br />35. Discrepancy <br />J <br />U <br />LL <br />G <br />W <br />38. Hazardous to Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />O <br />fn <br />W <br />O <br />EPA Form 8700-22A (Rev. 3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />