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Please print or type (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMS No.2050.0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.tW 23.Manifest Tracking Number <br /> (Continuation Sheet) r' 289()()q()0Q2 ( 5 OF 9) 005870814 JJK <br /> 24 Generators Name <br /> Lawrence Livurmore Natlorsal LaboratorTSite-300 for NNSA P,O. Bax 808 f L-78E Livermore CA 34551 <br /> 25 Transporter _ _ Company Name US EPA ID Number <br /> 26 Transporter-- _ Company Name U.S EPA ID Number <br /> 27a 27b.U.S.DOT Descdption(including Proper SNpprng Name,Heard Class,ID Number 211 Containers 29 Total 30,Unit 31 Waste Codes <br /> HM and Packing Group(if any)) r r No Type Quantity WtNol <br /> 35. Non-RCiu hazardous waste,Solid Ire±fn)DoPDm-1 <br /> 36. Mon-RCKA hazardous waste,solid(grease,seaAantl DOPOUD-1 <br /> 37. Nan-FICKA hazardous waste,solid(lubricants.molecular steam <br /> c 3E. Non-89,to hazardous waste,liquid(water contaminated wrth <br /> --yanunc and and melarmne) DOPt' ID-1 <br /> LU <br /> z <br /> 39. Non-ACRA hazardous waste,solid(absortent contaminated with <br /> aetrolsum hydrocarbzns)Donlr33-? 223 <br /> 40. Non-e CRA hazardous waste,solid I_debns Cofrtaminated wrth <br /> aetroleum hydroc2rbcnsj DGPOO44-1 <br /> 352 <br /> 31. Non-RCRA hazardous waste,solid(rags r:.c7ntaminated with <br /> aeTrolaurn hydrocarbons)DOPOW4-1 <br /> ?23 <br /> lLi tion-nutA hazardous waste,solid#aluminum and steel arming: <br /> II��I j0P0, (-Nj.1R- <br /> z72 <br /> 43. Non-�RCRA hazardous waste,s--lid(absorbent contaminated wr+ <br /> ->rtreleurm hydrurarboms)DOP0104-I 223 <br /> a. Kon-RCRA hazardous waste,solid{debris contaminated wrth <br /> ,3etrolsurebydna arbons)DOIPM 4-1 <br /> 223 <br /> 32.Special Handling Instructions and Additional Information <br /> a 33.Transporter--Acknowledgment of Receipt of Materials <br /> F Printed/Typed Name 9iprgrun IJor.: 03j <br /> n. <br /> 33 Transporter _Admowledgment of Receipt of Materials <br /> Printed/Typed Name a Month Day hr <br /> H <br /> 35.Discrepancy <br /> J_ <br /> L) <br /> O <br /> rw <br /> 3E +tawdous Waste a Management Method Codes 1e,codes for hazardous waste treatment,disposal,and recycling systemsl <br /> Uj <br /> C3 <br /> v, <br /> EPA Form 870D-22A(Rev.3-05) Previous editions are obsolete DESIGNATED FACILITY TO GENERATOR <br /> =t-j <br />