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State of C,lifornia—Environmental Protection Agency - <br /> Form Approved OMB No.2050-0039(Expires 9-3094) S@t? Instructions on backO� FD. Department of Toxic Substances Control <br /> Please print or type. form designed for use on elite(I2pitch)qkr. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 .Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST 2 4 7 of 1 <br /> 3. Generator's Name and Mailing Address SfateAatttfesY(otument (ua56h1�� t� <br /> Lawrence Livermore National Laboratory, Site 300 ON* <br /> 7000 East Avenue, Livermore, CA 94550 State eneratar"IrZ ��� <br /> 4. Generators Phone ( 51Q 422-1825 Attn: J. Schreiber L-620 a� : <br /> t <br /> p 5. Transporter 1 Company Name 6. US EPA ID Number C.Slate Trionspo- <br /> s Dco �f �f. <br /> Lawrence Livermore National Laboratory ���� � <br /> rt®rf, <br /> :P«tetN2 "7 " <br /> y a <br /> r�nsportertt- <br /> -� 7. Transporter 2 Company Name 8. US EPA ID Number � L� ` <br /> U $ ramsToHecr, <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G ateaalrty's`fD �� i ., <br /> ERICKSCIN INC. , NSA <br /> DL 255 Parr Blvd, Richmond, CA 94801 <br /> Xaa <br /> U 12. Containers 13. Total 14 Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T Quanf Wt/Vol "1VJastslvttt „,T <br /> St <br /> a. <br /> Non RCRA Hazardous Waste,Solid(Empty Containers Last �2 <br /> J� G Containing Diesel FueQ(With associated piping) <br /> C'+ E <br /> ado N b. State <br /> 00 E ' <br /> v <br /> CN R Ell <br /> o A <br /> 0 T C. State <br /> 0 <br /> R <br /> w <br /> Z State <br /> Z d• <br /> LU <br /> Uptyl <br /> N y <br /> Z �{CL <br /> dditioitiot`` " € C�d45" Ste AbOVC <br /> ♦'M.. i <br /> 1 IsJC: i*-�-• <br /> Uj $ <br /> t� <br /> JNo is ` ' <br /> Z f.M K <br /> x <br /> Q 15. Special Handling Instructions and Additional Information <br /> c 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 /> J 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> J <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 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> Nthreat 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 A O / 1,57713 <br /> U <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> U, A Printed/Typed Name _ Signature Month Day Year <br /> w s / 7 <br /> 0 18. Trans orter ckn wled ;men of Recei`t of Materials <br /> W T PMonth Day Year <br /> Lrinted/Typed dame ignature <br /> O R <br /> N19. Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> i <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 />