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F ease print or type. (Form designed for use on e•.ite H 2-nitrhl tvr,pwritPr i <br />ENA Form 8700-22A (Rev. N5) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />21. Generator ID Number <br />CA2890090002 <br />22, Page <br />F uirrr nNYruvvu. umo rvu. [uZ)u-uu'1v <br />23. ManifestTrac e <br />(Continuation Sheet) <br />_ ._ ., <br />�' uU ) JJK <br />24. Generator's Name Lawrence ermore one Laboratory a or <br />P.O. BOX 808 / L-786 <br />Livermore CA 94551 <br />25. Transporter Company Name U.S. EPA ID Number <br />28. Transporter Company Name VjFjo�,j .17—N`(AL _U..EPA 10Number <br />vP <br />V r NI -1 I <br />27a. <br />27b. U.S. DOT Descriptton (induding Proper Shipping Name, Hazard Class, ID Number, <br />28. Contilners <br />29. Total <br />30. Unit <br />HM <br />and Paddng Group (if any)) <br />Quan�ty <br />WWoi. <br />31. Waste Codes <br />No. <br />Type <br />25. Non-RCRA hazardouswaste, liquid (adhesive) (DOP0120-1) <br />331 <br />1 <br />DF <br />5 <br />P <br />26. Non-RCRA hazardous waste, liquid (antifreeze) (DOP0010-1) <br />343 <br />1 <br />DM <br />173 <br />P <br />27. Non-RCRA hazardous waste, liquid (glycerine) (DOP0086-1) <br />343 <br />1 <br />DF <br />49 <br />P <br />28. Nort-RCRA hazardous waste, liquid (photo chemicals and <br />paints) (DOP0120-1) <br />1 <br />DF <br />92 <br />e <br />gal <br />w <br />29. Non-RCRA hazardous waste, liquid (silicone elastomer, curing <br />,31 <br />agent) (DOP012(-1) <br />1 <br />IIF <br />35 <br />P <br />30. Non-RCRA hazardous waste, liquid (water contaminated rAth <br />monoethanolamine) (DOP0010-1) <br />343 <br />1 <br />DM <br />309 <br />P <br />31. Non-RCRA hazardous waste, solid (absorbent contaminated <br />with petroleum hydrocarbons) (DOP0104-1) <br />1 <br />DM <br />128 <br />P <br />223 <br />32. Non-RCRA hazardous waste, solid (adhesive, sealant) <br />fDOP0120-1) <br />331 <br />i <br />OF <br />25 <br />P <br />33. Non-RCP.A hazardous waste, solid (debris,:ontarrinated Nith <br />petroleum hydrocarbons) (00P0044-1) <br />2 <br />DF <br />79 <br />P <br />223 <br />34. Non-RCRA hazardous waste, solid fdebds contarranated with <br />petroleum hydrocarbons) (DOP0044-1) <br />1 <br />DF <br />13 <br />P <br />223 <br />32. Special Handlirg Irutructons and AddiVonal Infonnadon <br />33. Transporter Acknowledgment of Receipt of Materials <br />PrintedlTyped Name Signature Month Day Year <br />O <br />a <br />rn <br />34. Transporter Acknowtedgment of Recelpt of Materials <br />Printedrryped Name Signature Month Day Year <br />H <br />35. Discrepancy <br />v <br />0 <br />36. Hazardous Waste Report Management Mediod Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />O <br />rn <br />w <br />0 <br />ENA Form 8700-22A (Rev. N5) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />