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f <br /> - M 7/1 �1 <br /> P e se print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.20500039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 2 , n rotor ID ran liest Tracking Number <br /> (Continuation Sheet) 8 90002 0058708$3 J1k <br /> 24.Generators Name Lawrence Llvermom National L aboratory5ite 300 for NNSA <br /> P i) Pvnx Afl6t 11 -?RA .iucrmr ria r'A gdrgl <br /> 25. Transporter Company Name US.EPA ID Number <br /> 26.Transpoder Company Name U.S EPA O Number <br /> 27a. 27b.U S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 26.Containers 29.Total 30.Unit <br /> HM and Parking Group(if arty)) No Type Ouantity WLNol. 31 Waste Codas <br /> X. <br /> 15. NA3-077 Mazardous Waste. solid,n o.s.JDUr}51: 9.111 JERG 171.1 D M 3ix F �00E <br /> GGFOOMBA-i <br /> 181 <br /> L6. NA3077, "zardouswaste soltd,mo s_jML%. 9. Ila DM 3037 P 0019 <br /> DOPOr332-1 <br /> aS1 <br /> 7. NA3077, hazat'dous Waste,solid,n.a.s.IL'040.f`002} 9. ;__ nM 144-3 F D040 F002 <br /> 1711 DGF€)iJ32-1 <br /> 351 <br /> 13. NA3077 Hazardlem Waste,solid,n_a_s.O ). 9.IFI [ERG 1711 r�► 18E a f?OCS <br /> ixiIP0036A-1 181 <br /> LU L9. 90,Rt,RBM-4 Pazardous waste,liquid.n_o s.tDor s. mu). 9 IA F 5E7 P €3011 0005 <br /> {Ru DDi.1j� (ERG 1Tl) DOFO7li-1 <br /> 541 <br /> 20, SCL NA221Z asbestos.9_lit(ERG 171) DOPOL31 1 ISM 72 <br /> 151 <br /> X/ tt. HU,NA.301i_ hazardous waste_sosta,n.o.s.tWi1; 9, ill IRR DM :7u P X11 <br /> G7iL) (Elitu L71) rZFW3-&A-1 <br /> 181 <br /> 22- NA3O82, Hazardous waste.tiquild,n.o.j.(M11). 9, HI (ERCG 171) 1 ` 485 a 0011 <br /> DiUFt7O13-i t <br /> Din 561 <br /> 21 bion-IiCRA.hazardous waste.solid(rags contaminated v-.. a,W 30 <br /> ,p_troleuns hydrocarbms)DGPODW1 <br /> 1�J <br /> 24_ Non-RCRA hazardous waste,solid(debns contaminated with F 1E <br /> petroleum hydrocarbons)00PXAiIi,-? <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Adunowiedgment of Receipt of Materials <br /> 1L— Pnnte0yped Name Signature Month Day Year <br /> a <br /> a <br /> Z 34.Transporter meet of Receipt of Materials <br /> PrintedlTyped Name Signature Month Day Year <br /> 35.Discrepancy <br /> J <br /> U <br /> a <br /> k <br /> a <br /> 36.Hazardous lasle ReportManagement Method Codes i e.,codes for hazardous waste treatment H#0101 and cycling systems) El Z <br /> h Wit" i 14W <br /> EPA Form 870022A(Rev.3-05) Previous editions are obsolete'. I ` ' DESIGNATED FACILITY TO GENERATOR <br />