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State of Crlifornia--Environmentol Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30-94) SCt@ IRSYrueYlORS OR bgCIC Of f7. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> his not required by Federal law. <br /> WASTE MANIFEST 2 4 7 of 1 <br /> 3. Generator's Name and Mailing AddressAjSf6te�,3ManifeiF`PocumentaNumb�er <br /> Ln Lawrence Livermore National Laboratory, Site 300 , <br /> 7000 East Avenue, Livermore, CA 94550B�atata�ienerato%s <br /> s(j 4. Generator's Phone ( 51Q 422-1825 Attn: J. Schreiber L-820 r ,;: ' <br /> p 5. Transporter 1 Company Name 6. US EPA iD Number C nState"Trainporters-AID ' r� <br /> C? Lawrence Livermore National Laboratory <br /> r � <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E'StUNy it <br /> ate:: <br /> F raode?s'Ph`otte 0 <br /> .)Z 9. Designated Facility Name and Site Address 10. US EPA ID Number G Stafeifaaltt�s fps & r 11 *1 0 ERICKSON INC. ,� �a <br /> J 255 Parr Blvd., Richmond, CA 94801 <br /> �U <br /> 12. COfifOlners 13. Total 14. Unit <br /> n' 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Na T Quantity Wt/Vol LY✓asfe:Nam <br /> 1Vr== a. St M <br /> Nan RCRA Hazardous Waste,Solid(Empty Containers Last 2` <br /> j, G Containing Diesel Fuel)(with associated piping) 00 0 C P EP µ <br /> N E <br /> aaoo N b. <br /> 00 E <br /> N R ERA <br /> ` <br /> v A <br /> O <br /> O T C. 95tate, <br /> 00 0 �#�_ <br /> R EPA/C+fher „ <br /> W i <br /> Z all. <br /> ... <br /> LU <br /> U EPA/Otltei nx <br /> W <br /> V) <br /> Z 14Adc[66ial lots 1s tioVe � {fi�prr�.�t'�f Iaig Codes-forl4Yast4s Lstod Abova p g`5" <br /> OCL <br /> n 'v., n l i Nf i il��lYlAg"�4 <br /> N <br /> UJI <br /> �,. <br /> Z <br /> Q 15. Special Handling Instructions and Additional Information <br /> a EMERGENCY CONTACT: (510) 447-6880 Reference Release#IWY0265 on invoice <br /> Z Wear protective clothing while handling These materials are NOT radioactively contaminated. <br /> = HWM Requisition Numbers H127269 and H127270. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> a. <br /> rnthreat to human health and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> O Printed/Typed Name Signature Month Day Year <br /> r Richard B Loden on behalf of LLNL Q <br /> U <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> W A Printed/Typed Name <br /> t' _ Signature Month Day Year <br /> � i j <br /> W P <br /> wa 18. Trans orterck wled emen of Recei`t of Materials <br /> T Printed/Typed dame rnatvre Month Day Year <br /> LL- <br /> O a <br /> W 19. Discrepancy Indication Space <br /> N <br /> U F <br /> A <br /> Z C <br /> I <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (12/91) To: P.O. Box 400, Sacramento, CA 95812-0400 <br /> EPA 8700-22 <br />