Laserfiche WebLink
kease Drint or tvDe. (Form designed for use on elite (12-oitch) tvoewriter.) <br />Pn m Al-aA Mild Wn Wun.nnla <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 />(Continuation Sheet) <br />2t. Generator ID Number <br />CA2890090002 <br />22. Page <br />5 <br />23. Manifest Tracking Number <br />006870461 JJK <br />24. Generator's Name Lawrence Lnrermore Natlonal Laboratorf Sne 300 roTNNSA 4 <br />P.O. Box 808 f L-785 <br />Livermore CA 94551 -" <br />EPA ID Number25, Transporter Company Name U.S. i • � �' - <br />26. Transporter Company Name U.S. EPA ID Number <br />,jjj:jC)N ENTAL HEALT <br />27a. <br />HM <br />27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (d any)) <br />28. Containers2g. <br />Total <br />Quantity <br />RUM <br />WLNoI. <br />!.,ty �s <br />31. Waste Codes <br />No. <br />Type <br />35. Non-RCRA hazardous waste, solid (debris contaminated with <br />petroleum hydrocarbons)(DOP0044-1) <br />a <br />DM <br />1437 <br />P <br />223 <br />38. Non-RCRA hazardous waste, solid (debris contaminated with <br />petroleum hydrocarbons) (DOP0044-1) <br />2 <br />DM <br />1337 <br />P <br />223 <br />37. Non-RCRA hazardous waste, solid (debris contaminated with <br />petroleum hydrocarbons) (DOP0044-1) <br />1 <br />DM <br />260 <br />P <br />352 <br />0 <br />w <br />38. Non-RCRA hazardous waste, solid (dirt contaminated with <br />petroleum hydrocarbons) (DOP0104-1) <br />1 <br />on <br />453 <br />P <br />223 <br />z <br />Uj <br />39. Non-RCRA hazardous waste, solid (dirt, absorbent <br />contaminated with 2-butoxyethanot) (DOPG104-1) <br />1 <br />DM <br />165 <br />P <br />ase <br />40. Nor-RCRA hazardous waste, solid (empty drum last oontain <br />petroleum hydrocarbons) (DOP0046-1) <br />1 <br />DM <br />35 <br />P <br />sit <br />41. Non-RCRA hazardous waste, solid (empty drum last contained <br />petroleum hydrocarbons) (DOP0046-1) <br />2 <br />DM <br />88 <br />P <br />sit <br />42. Non RCRA hazardous waste, solid (non -PCB ballasts) <br />(DOP0029-1) <br />i <br />DM <br />144 <br />P <br />223 <br />43. Non-RCRA hazardous waste, solid (non -PCB Capacitors) <br />(DOP0029-1) <br />3 <br />DE <br />53 <br />P <br />223 <br />44. Non-RCP.A hazardous waste, solid (non -friable asbestos debris <br />contaminated with petroleum hydrocarbons) (DOP0044.1) <br />1 <br />DF <br />44 <br />P <br />223 <br />32. Special Handling Instructions and Additional Information <br />33. Transporter AcknaMedgment of Receipt of Matedialls <br />tX <br />O <br />a <br />Printed/Typed Name Signature Month Day Year <br />to <br />34. Transporter Acknowledgment of Receipt of Materials <br />Prtnted7yped Name Signature Month Day Year <br />J_ <br />V <br />LL <br />O <br />W <br />M. Discrepancy <br />a <br />36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyding systems) <br />w <br />W <br />O <br />EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />