Laserfiche WebLink
Mote,,of Cg4lornio—Environmental Protection Agency � ` d ' <br /> Form�Ap roved ,MB No.2050-0039(Expires 9-30-94) XjSee Instructions on bock p e 6. �(�� <br /> -- - - Department of Toxic on+ <br /> r�.ease print or type:" form designed for use on elite(12p ewriter. Sacramento <br /> UNIFORM HAZARDOUS <br /> I. Generator's US EPA ID No. Manifest Document No. 2. Page f Information in the sho <br /> is not required by Federa <br /> WASTE MANIFEST 1 CI A! 21 81 910'_0 1 9 10 10 10 l2 91 4 ' 0 6 4 of 1 <br /> 3. Generator's Name and Mailing Addren <br /> ® LAWRENCE LIVERMORE NATIONAL LABORATORY, Site 300 <br /> 7000 East Avenue, Uvermore, CA 94550 <br /> G-ri—ators Phone (510) 422-1925 Attn: A. Wilt L-620 <br /> O Transporter I Company Name 6. US EPA ID Number1-9 he <br /> ?' <br /> - <br /> J y we7C�G L/tlC�.f�t'Ic IV/3•Td�"� <br /> Q< 7. Transporter 2 Company Nome 8. US EPA ID Number <br /> U <br /> LO Q Z 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> MO A. LAW,Qrt:c,� 4/vr"-'ti'Xc�� <br /> T. .4 Btf�f�T 'y <br /> , 3'T ,41VG ' 411,049", <br /> /1,049 JLr¢ <br /> 11. US DOT Description(includingProper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> Z P p PP g No. Type Quantity Wt/Vol <br /> CV 3 RO Waste Diesel Fuel,3, NA1993, III <br /> (7) G <br /> RQ D001 <br /> C) <br /> E t ) 001 TT G <br /> oo N b.00 <br /> , <br /> E <br /> I R <br /> o T C. z. <br /> 00 <br /> 0 <br /> R Hr <br /> w ---.i ti i <br /> � M <br /> , . <br /> Z d. <br /> UjU <br /> U <br /> W <br /> 71 ' <br /> tet. <br /> V) <br /> �R <br /> q <br /> LU <br /> J <br /> Q <br /> 0 15. Special Handling Instructions and Additional Information <br /> Q EMERGENCY CONTACT: (510) 447-6880 LLNL Shipping Doc.#S- �GZ%c7 <br /> Z IT Job#: 151960 Reference Release #IWY-0415 on the invoice. <br /> _ Wear protective clothing while handling These materials are NOT radioactively contaminated. <br /> J 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 /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> V <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 /> 0-1 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 /> i threat to human health and the environment;OR, if 1 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 /> 0 Printed/Typed Name Signature Month Day Year <br /> Richard B. Loden on behalf of LLNL 01 q1 91 <br /> Z T 17. Transporter 1 Acknowled ement of Receipt of Materials — <br /> w R <br /> U, N Prin /Ty ed Name �. r I n).Q},• Si n r ./ Month Doyp Year <br /> s r 3 C[j <br /> w V <br /> 0 18. Transporter 2 Acknowled ement of Receipt of Materials <br /> LU a Printed/Typed Name <br /> TSignature Month Day Year <br /> LL E <br /> 0 4 <br /> w <br /> N 19. Discrepancy Indication Space -- <br /> 1 <br /> Q F <br /> U A I <br /> Z C <br /> 1 <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item i c. <br /> T j Printed/Typed d Name onth ?cti + <br /> I ---- -" <br /> � YPeSignature "- 6� ear <br /> Y <br /> ti+. <br /> tt <br /> 1R.::Ll r <br /> DCC NOT WRITE BELOW THIS UNE. ----� <br /> DTSc <br /> 8022A :'Z'9?.: <br /> EPA 8704-22 <br />