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KE1LI ) Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS I'-Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CA2890090002 ) 11325-423-420S100,9R70808 JJK 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Lawrence Livermore National LabaretcrI 4!t&300 for NN4A Lawrence Uvesrnore Natlicnal Lalacratory Snte 300 forNNSA P.0. Brix 2591 L-796 Livermore, CA 4-1551 Car-31 14ollaw Ahad, Fray CA 915376 Generator's Phone: 925-4Z2-1 25 ATrN:&Hnnine 6.Transporter 1 Company Name U.S.EPA ID Number Clean Harbors Environmental Services Inc- MA00393222SO 7.Transporter 2 Company Name U.S.EPA ID Number tl.Designated Focality Name and Site Address U.S.EPA ID Number Clean lN-id*crs Buttorriwilfa*i.LLC CA09$0575276 2500 West Loliiem pond ®sttcn-.vA!ow, CA 93206 FacliitysPhone: Fc-ii.7r.t-Aron ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1i.Total 12 Unit HM and Packing Group(if any)) No. Type Quantity Wt Nol 13,Waste Codes 0 1' Nan-RCCA hazardous waste,solid(non-PCH rapa;rors) 3 fly} ❑„q 273 2 Nan-RCRA hazardous waste.solid(non+CE r:apacnors) OM SAD 223 3.Non-RCRA hazardous waste.solid(ncrn-PCB capacitors) 7rn 223 4. Pion-F(CRA hazardouiwaste,solid jnen-PCE capacitors) Cllr 4iS7 tD:PM234.) 223 .14.Special Handling Instructions and Additional Information Em"tnci Respon;e Vttrner9i5-LI3. 205 Ccnzact narpie.t1.NL,gmergi ncyr Dtspatrh - Load No. STWL6-06, Shia OOC No.=-229324 . ft6}srarlca r�ltaSe nutrlber L547&57 ufl tnYtv!_e. 5��tii�:llr�ie}f i��ntatncrnuri� fi 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name arta are classified packaged marked and Iabelediplacarded,and are in all respects in proper condition for transport according to applicable international and national govemrrental regs!aaens.If export shipment and am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the aStached EPAAckrwwledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26227(ai i if 1 am a large quantity generator)or(b)(ff I am a sma!I quantity generator)is" Generator'slOtferor's Printedfryped Name Signature f/<�j Month Day Year Scott A- Graham an behalf of NNSA a j b r: 11 g J 16.Intema'aonalShipments � �-Y s ❑Import>4 U.S ElExportfronttf;5� Port orenb}n'exi1: Transporter signature(far exports only): Dare leaving U S.: UW 17.Transporter Acknowledgment of Receipt of Materials TrarySpgRer 1 Pnntedliyped Name �5ignat re Month Day Y ar Q TrAnsporter 2 Printedfryped Name Signature [ Month Day Yee t- 16.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑i ❑ ype Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 1 8b.Alternate Facility(or Generator) U.S.EPA ID Number V Faalitys Phone: tau 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes forhazardouswaste treatment,disposal,and recycling systems) 2�} 4. 20.Designated Facility Owner or Operator;Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a / ! PnntediTyped Name Signature / ;' Month Day Year EPA Farm 8700-22(Rev�3-04 Previous editions are obsolete. DESIGNATED FACIL{TY TQ GENERATOR