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Please print or Noe. (Form desioned for use on elite (12-nitchl tvnewritar ) <br />`"1° "' """ au civ. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />- <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator IO Number <br />I CA2890090002 <br />22. Page <br />runn „PProveU. UMo NO. [UdU-VUJU <br />23. Manifest Tracking Number <br />005870331 JJK <br />24. Generator's Name Lawrence Livermore Natlenat LaDoratvy Site 300 for NNSA <br />P.O. Box 808 / L-786 <br />Ligermore CA, 9A551 RECEI F:1 <br />25. Transporter Company Name U.S. EPA ID Number <br />JAN 14 2016 <br />16. Transporter Company Name U.S. EPA ID Number <br />27a, <br />HM <br />27b. U.S. DOT Description (induding Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28, Containers <br />29. Total <br />Quantity <br />30. U ' <br />y I N01 <br />ALTA- STM EN <br />No. <br />Type <br />55. Consumer commodity, ORM-D (aerosols) [ERG 171] <br />(DOP0112-1) <br />1 <br />DF <br />4 <br />p <br />711 <br />58. Waste, Consumer corrmodity, ORM-D (aerosoh [ERG 17 1] <br />(DOP0112-1) <br />1 <br />DE <br />s <br />p <br />-'al <br />vols <br />57. VAlste, Consurner corrdnodity, ORM-0 (aerosols) (ERG 17 1] <br />(DOP0112-1) <br />1 <br />DF <br />25 <br />p <br />gal <br />boos <br />0 <br />z <br />M <br />58� �4,Ur1 sat�,:sz�9 e, mr_Tc.uf%y <br />-,�r, irLc��� � z �p�o�-1 � '- �� <br />W <br />0 <br />32. Special Handling Instructions and Additional Information <br />33. Transporter Acknowledgment of Receipt of Materials <br />V <br />iY <br />0 <br />o_ <br />Printed(ryped Name Signature 6lonth Day Year <br />Z <br />34. Transporter Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature Month Day Year <br />r <br />r— <br />U <br />Q <br />tL <br />O <br />W <br />Z <br />0 <br />35. Discrepancy <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />W <br />0 <br />FPA c.,.,.. o7nn eon 10-., o nc� n__..:_.._ _ �.•___ ___ <br />`"1° "' """ au civ. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />