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Please prtlsl orType.(Form designed for use on elite(I2-pitch)typewriter.) Form Approved.OMB No.2050-D039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21.Generator ID Number 22.Page2 <br /> 3.Manifest Tracking Number <br /> (Continuation Sheet) IC;A2890a9WO2 3 OF 6 f1OS$71s7GJ9liK <br /> 24 Generator's Name <br /> Lawrence Livermore National Laisoratvey5ite" 300 for NNSA P_O. Box BOB/L-766 Livermore CA 94551 <br /> 25.Transporter Company Name U.S EPA ID Number <br /> 26 Transporter_ _._ Company Name U.S.EPA ID Number <br /> 27a: 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30 Unit <br /> HM and Packing Group(rf any}) Na Type Quantity WLNoI 31.Waste Codes <br /> 11. Ncn41C?.A hazardous waste,solid(grease and detergent) DM 110 <br /> D17�71�0-1 <br /> 337 <br /> i.6. Non-RC'i<tA hazardous waste,soled(grease)X7120-1- <br /> DF 32 <br /> 331 <br /> 17. Nan-R RA hazardous waste,sroled(gre3so)DOPO120.1 DM 132 <br /> yr` "r. 331 <br /> a !& Nan-RCRA hazardou&wave,hqusd(epoxy)t OP01Z0-1 �r � <br /> 33! <br /> Uj <br /> I5_ Non-KCRA hazardous waste.solid(silicone elastomer)DOPO12D- 7 OF 7 P <br /> 331 <br /> 2a Non-RCRA hazardous wasi e:hqutd(hydrauls-0111 DOP0120 �M 1613 <br /> 223 <br /> 21 Non-RCitA hazardous waste.liquid(Luning oll and glycerine) <br /> t,rsw isu <br /> DOPO120-1. <br /> 331 ?2! <br /> 22.. Non-KCRA hat rdous waste,liquid(damaged n�n-PCE capaurorl 1 pF 5c <br /> 7.3 <br /> 73. Nan-RCCA hazardous waste,Solari(debris cofttminated with OF 107 r <br /> petroleum hydrocarbons)DOPOO43-1 <br /> 24 Non4RCIRA hazardous waste,solid(debns contaminated Wirth UPA 49 <br /> petrokuni hydroc3rbans)DOPM44-1 <br /> 22-3 <br /> 32.Special Handling Instructions and Additional Information <br /> 143.Transporter Acknomedgment of Receipt of Materials <br /> F Pnn1e6Typed Name Signature Month Day Y.a <br /> a <br /> O <br /> v.. <br /> Z 34.Transporter ent of Receipt of Materials <br /> Ponta ayped Name Signature Month Day Ycar <br /> H <br /> 35.Discrepancy <br /> a <br /> t� <br /> D <br /> LU <br /> 36.Hazardous Waste Management Method Codes a cedes for hazardous waste treatment, t sal,and recycling systems; 1 <br /> to <br /> U C3 <br /> 'l H lo 4) o I --I J . i-11 <br /> EPA Fonn 8700-22A(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />