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X127270 <br /> LAWRENCE LIVERMOhE NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM Use Only Page of J- <br /> 1It (lding No: 2. oom No: 3. RMMA 10.Hazardous Outer Container/Retention Tank ID: Overpack? scheduled waste nun Date: Void Requisition: <br /> Com' } _ tJ X U Yes_ No Properties ❑ves ❑No _ ❑DATE:_) _/ <br /> - -- Tozic <br /> 4.WA o: 5.Workplace n D le: 6.Account No: 12.Outer Container 13.Outer Container Size: ❑HWM Waste Run Inftiels/D e <br /> i <br /> 17 _'. -./._-1 a/_. � j..3 s 3 - &I Corrosive Type'. ❑ 1 gal ❑330 gal <br /> ❑Ignitable ❑ 5 gal ❑660 RTO <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste. ❑No El gal ED to LLNL <br /> ❑Yes, Activit Codes enter u to four): W_-- W W W ❑ Reactive WTO <br /> Activity ( p ) ❑Can ❑ 7 gal 750 gal <br /> - - ......... <br /> - --- ---- ❑30 gal ❑1000 gal Commercial Shipment <br /> 11.Waste Form: ❑Carboy ❑55 ai ❑5000 gal <br /> Comments: ( 'Solid ❑Drum g Secured Pickup <br /> P(Solid gal ❑1x1x1.5 If <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes ❑No ❑Liquid ❑Tank-Fixed ❑2x4x7 it ❑HWM Field Pump Out <br /> 8.Profile No: 9.Directorate: I ❑Sludge ❑Tank-Portable El4x4x7 it <br /> -1 ryf ai ❑HWM Generated Waste <br /> H P —_-- _ ❑ Gas Other: N_K Other <br /> --- ❑cu it JE1 Sewer: DATE:_--/_/_RSDR M: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> -NO. H Normality SAMPLE NO. CODE Amount per nem units <br /> For RMMA Waste a Normality Required if pH s 2 or pH a 12.5 USE CONTINUATION FORM FOR ADDITIONAL ITEMS <br /> 20 Was the waste kept isolated from M jr <br /> any,peration that could have 22.Describe other controls used to prevent radioactive contamination: <br /> _­­ <br /> produced radioactive contamination _ <br /> 23.1 certify,to the best of my knowledge,that the information provided on this requisition is rrect, understand that I may be liable to State and Federal prosecution by intentionally <br /> Iusntg a glove box,vent hood,etc.)? providing false information. <br /> Yes I-] No❑ <br /> Generator Name P <br /> , ill nc.full rad analysis required) � r�,(rf�Last'First): C=✓� -q)3 <br /> — -' � 1'G p y HWM(Print Name-Last,First): Ext.: <br /> Y 'q ) ) L-Code: Ext.' ..t/ Inspected b_ <br /> I21 ,Nas the Waste exposed to article �" ' r + <br /> Ii;:.ms capable of inducing radioactivity Signatur Employee No.. Dale. Signature: Employee No.: Date: <br /> by a fiv9tion. Yes No El7 <br /> (11 yes,full rad analysis required)- - _yt / � '4. _-- 5.37j 9 �v//� , <br /> I fGht RCH RCH P Origin Form EPA NO. DTSC NO. MSDS NO. azardous Properties Handling Code: By: <br /> Prefix Code Code p <br /> T C I R — <br /> 0 EJ FJ <br /> ' --- Date: Loc: <br /> I �. � ❑ C J^ 171ChemicalCompatibility Code: <br /> I <br /> -- <br /> i I H W 1"1M SHIPPING <br /> - - --- Department Generating Waste: <br /> T�Yf- <br /> UCt 1 / HWM equisitionA gn ure) <br /> 1993 [ �__i �__� 1-1 <br /> 7 ❑ ❑ �l ❑ En4o ee o.: � ate: <br />) I <br /> I i.-+314 E3 If , '.00/090? — - <br /> White—HWM Copy <br />