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0 10 'Y <br /> X3 P594 LA27 I.WJAIA <br /> Please pant or . Form duel nod tar Mon 12 cft) ;tar. Form A0 +red.OMB No.206D-0089 <br /> UNIFORM KAUMCK16 1.Gvase'or' r I.Pepe 1 of 3.ErnetpaglAmonss mare Ma ra np Nu <br /> WASTE MANIFEST �$ 2 925-423-4205 0 0 5 8 7 0 8 8 5 JJK <br /> 6.Gerrereofa Hems and WMB2AddRU ; GeneraWs Site Address(if dlkmrd then Maling address) <br /> Lawmrtce Uvttrtstm Natksesal Labbtasnry Site 300 rorNNSAP.0.0ox908 Lawrencr Livermore Nationtsi Laborstary Site 300 rorNNSACorral Hallow <br /> J 1-726I.Wi rmem t A DAS51 Arad Tracy CA 9S176 <br /> 1 <br /> ceneniWaPtane:9 22-1925 1`TfN:SKppjrjA <br /> S.Transporter 1 Compa rw me D.S.ERA ID t4inber <br /> Tri-State MotixTran Co.` MOD09SOMEM <br /> T.Trauoorler 2 Cawmy Men r US.EPA ID Number <br /> S.Dedpneted eolAy ,and Site Ado U.S.EPA 0 Number <br /> Clean Harbors CWh%.LLC 1763'r Way 471 Coltatt LA 71417 LAOSSIOSS791 <br /> Fedr Phone: 31$- 27-344� :+: <br /> 9e. W U.S.DOT Dearow pndntdng Proper 9H0ft Name.Hazard Clan,ID Number; 10.Contknm 11.Totel 12.Unt 13,Wests Codes <br /> HM end IGMWW8nY)) No. Type Quandty WLNoL <br /> 1'UN Mile,Anxiesiaxplosive.warem*inserdtitive,i aN 2 DM 56 P D003 <br /> (EX19980SR117)jI 998 118) popolwl I <br /> 352 <br /> X12.UN04ST,V+=e.CtlaWmg bursting,plastics bonded,lLw 1 DM 16 p 0003 <br /> Cope,=(EX ExL495 7)(EX7995060008) [EiG 11.21 35 <br /> 3'RQ. rite,A ,e*osive,Mo.s.(F=.TNT). 3-1D(RQ 1 DF 114 P D 03 <br /> 000300T 5P 1S=) [43 1121 DOP'0138-1 3+ram <br /> UN@2$*aste.MM.minted,LID(EXL99r1110" [ERG 1121 2 OF 70 P 0 3 <br /> DURDL42-I; 352 <br /> ib.Sj adel Hv4ft Ir>btr AWs.and .at ear <br /> emergency Response Phone>SF42342n5 Contact 1ltlarna�t!.NL Emergency ENS.Patch.Load No.COL39-OL Ship 005 No.5-23rMZ <br /> Regents relw4e number V==on invoice <br /> 15. UENERA101'i'S 0FFWWS CE tTWr-K M: 1 hereby dedene Ihel the caderb of 26 rnnerpnmenl are fidl and a=mtely assodbed above by the proper shipping name.and am ciassi led,padaged, <br /> marked arrd 1a ed,end are br 4 iesp xis In pmpsr ca xkbon for trawpott a;ordng to appttcablo international and national povemmentel regulaoom R export shbm�et and I am the Primary <br /> Exporter,I t>etlry�steels of itris o4*rrRenl conform 10 the serma al the eaacW EPAAdmakiedgrnerd of Con <br /> I certify that th v�ete+r�imiratbn rialemabt iderdified b 4D CFR 26Z27{a}{il I am a�quardity p )or(bl(If I a emlh generator)b true <br /> Generalor's*11srore PninlWyped Name f Sign re Mort Day Year <br /> Sean Garvey oil behalf arf NNSA ff-- <br /> -j 16.bdertrettorret Sidpments ❑ImpW6' l Q U.S. LJ Export AZ US S Porn of tuwyfrrxar <br /> Transporter kFftrc(form m ordy): Date leaving U.S.: <br /> a 17.TransporWAdmnledgmerdd Pic* fUr furs <br /> Transporter 1 !leers Spasms Moan Day Year <br /> Transpater2 P*�N" Month Day Year <br /> .i <br /> ta.DisarepencY <br /> 198.Dhtsepertcy irrdcsgarSpaae ❑ *AY ❑To ❑Residue ❑Pedal Reoc doa ❑Fndl Refedlan <br /> W"Fest Re!ere r.NL:mbvr. <br /> 1Bb.ANnrnafe Fecih{a } U.S.EPA ID Number <br /> e� <br /> Facitys Phone: <br /> lot:Vqnatum otAwniderwity(ar i, More Day You <br /> 19 Hazardous Waste Repdt Management AAe * Cots fi,_codas for hazardous waste traptrnart,deposal.and recydrngsplemslcri <br /> 29. noted Ftarlity Owner or Operelpr iecelpt a+hazardous matelots m4vd by the ma exile t as riled <br /> Pda M 10, <br /> Y <br /> . c r <br /> E 8700 22WTXPrtW ash . D£ IGNAT£D FACILI TO DESTINATION STATE(IF REQUIRED) <br /> 1 <br />