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H127269 <br /> LAWRENCE LIVERMOncz NATIONAL LABORATORY <br /> S' HAZARDOUS WASTE DISPOSAL REQUISITION ❑ HWM Use Only Page 1 of\ <br /> 1.Binding 2. Room]No' �3. RMMA: 10.Hazardous Outer Container/Retention Tank ID: Overpack? scheduled waste Run Date: Void Requisition: <br /> S `T , E] Yes No Properties: []Yes []No <br /> ❑DATE:_) / <br /> Toxic <br /> 4.WA No: 5.Workpla e nd pit 6.Account No: _ � 12.Outer Container- 13.Outer Container Size: Initials/Dat <br /> W? <br /> �J e / ❑ Corrosive F-1 HWM Waste Run /�G %1� /' Fl--� <br /> --—�'% �I---�— -� .� � 3- G /__ Type: ❑ 1 gal ❑330 gal <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste (Vo <br /> ❑ Ignitable ❑Box ❑ 5 gal 1:1660 gal ❑Off-Site to LLNL RTO <br /> ❑ Reactive ❑Can ❑ 7 gal ❑750 gal ( _ mmercial Shipment WTO /— <br /> Yes, Activity Codes(enter up to four): W __ WWW__.___ ❑30 gal El 1000 gal 0 0 <br /> 6 <br /> 11.Waste Form: ❑Carboy ❑55 al ❑5000 gal ❑Secured Pickup <br /> Comments: 9 p <br /> 9Solid ❑Drum El 85 gal ❑1x1x1.5 ft <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes C.ry,No ❑ Liquid ❑Tank-Fixed ❑2x4x7 ft ❑ HWM Field Pump Out <br /> 8.Profile No: 9.Directorate' ❑ Sludge <br /> ❑Tank-Portable ❑4x4x7 ft ❑HWM Generated Waste <br /> 1} _`1 / gal <br /> H P j ❑ Gas Other _-f_/1/�_k Othec_ _._ ❑Cu ft ❑ Sewer: DATE:_/_/_RSDR#: <br /> • 14.ITEM 15AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. SAMPLE NO. CODE per It— <br /> _ _2.H - Normality Nnount <br /> rJ�vCs t I= � tv tJ ` P •(� <br /> Milk <br /> (XW <br /> For RMMA Waste *Normality Required if pHs 2 or pH z 12.5 USE CONTINUATION FORM FOR ADDITIONAL ITEMS <br /> 20.Was the waste kept isolated from <br /> any operation that could have 22.Describe other controls used to prevent radioactive contamination: <br /> prnuuced radioactive contamination 23.1 certify,to the best of my knowledge,that the information provided on this requisition is correct.I understand that I may be liable to State and Federal prosecution by intentionally <br /> (using a glove box,vent hood,etc.)? providing false information. <br /> Yes❑ No ❑ <br /> 111 no,full rad analysis required) Generator Name(Print-Last,First): L-Code: Ext.: Inspected by HWM(Print Name-Last,First): Ext.: <br /> 7.3 i� <br /> . <br /> 1 1 *1-1's the waste exposed to particle t��' Y'�l v-�'� <br /> $ ' SV <br /> -- — ---- -----1-- L w� <br /> �i> n�e-p lbie of inducing radioactivity Signatu Employee No.: Date Signature: Employee No.: Date: <br /> 'hy activation? Yes❑ No ❑ � 5 <br /> Q <br /> (if yes full rad analysis required) „ji.�1 fi�t.�-C.c� / y ��Z <br /> i nCH RCH P EPA NO. DTSC NO. MSDS NO. Hazardous Properties Handling Code: By: <br /> ITEM Origin Form p <br /> Prefix Code Code <br /> T C I R <br /> Date: Loc: <br /> ❑ ❑ ❑ _/_/_ <br /> r ❑ El El ❑ Chemical Compatibility Code: <br /> ' I <br /> i 1 Y Y M SHIPPING ❑ ❑ ❑ ❑ De artment an rating Waste <br /> --- ---- -- --- —OCT1. �� ❑ ❑ ❑ ❑ H e uisitio vp((S nature) <br /> _ <br /> 01 111ste: <br /> 104 <br /> LL 53.14-6(Rev.3133) 7600-70.302 <br /> White—HWM Copy <br />