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, t <br /> A State of ColifOrni—E-vil4mmen'-1 Protection Agency <br /> For-.7XppF3"WoMB No.2050-0039(Expires 9-30-94) See Instructions on b.ckqe 6. � Department of Toxic ntrol <br /> Pleose print or type. For-,designed for use on elite O2pitch writer. Sacramento, <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the sha <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST <br /> is not required by Federa <br /> 1 C� -. : --,21 31 91 C: 9 4 1 0 of <br /> 3. Generator's Name and Mailing Address <br /> i <br /> 01 LAWRENCE LIVERMORE NATIONAL LABORATORY. Site 300 <br /> '7'jOO Last Avenue. U'VeMlore, CA 94550 <br /> 4 :,enerator s Phone 15 101 42_2-1925 A I.-;: A. W ! <br /> L-62�) <br /> O 5. Transporter I Company Name 6. US EPA ID Number <br /> NG Chemical, Inc C1 Al DI 91 .3101617151 aSfsl <br /> 7. Transporter 2 Company Name S. US EPA ID Number <br /> U <br /> < 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> Z <br /> Ix USPCI Treatment& Recovery Services <br /> U110 <br /> 1021 Berryessa Rd, San Jose, CA <br /> Cl Al DI 01519141914131110 <br /> I <br /> 00 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. _ Type Quantity Wt/vol <br /> 00M 0. <br /> N1= PIQ Waste Diesel Fuel, 3, NA1993. ill <br /> CT) G RO (DO01) CT 0 0 1 T <br /> 04 E O <br /> 0 <br /> 00 N b. <br /> 00 <br /> E <br /> 04 R <br /> 0 A <br /> 00 T C. <br /> 0 <br /> 0 <br /> R <br /> Uj <br /> d. <br /> Z <br /> Uj <br /> U <br /> Uj <br /> V) <br /> Z <br /> 0 <br /> Uj <br /> arZ <br /> 0 15. Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT: (510) 447-68310 LLNL Shipping Doc,#S--Y492,3F�-, <br /> Z IT Job# 151960 Reference Release # IWY-0415 on the invoice. <br /> LU Wear protective clothing while handling These materials are NOT radioactively contaminated <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 /> < 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 e I <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 /> threat to human health and the environment;OR, if I am a small quantity generator, I have mode 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 13 Loden on behalf Of LLNL <br /> U 01310 1 1?1 4? <br /> Z T 17. Transporter I Acknowledgement of Receipt of Materials <br /> W <br /> o A Printe Typed Nome <br /> Signcrt.30�/ Month Day e., <br /> LU P s <br /> 0 18. Transporter 2 Ac Ki of Materials <br /> LLJ R — <br /> T Printed/Typed Nome Ltanature Month Day Year <br /> LA- E <br /> 0 R <br /> Uj 19. Discrepancy Indication Space <br /> V) <br /> F <br /> U A <br /> Z C <br /> 1 <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 Nome Signature month Day Year <br /> Y <br /> f <br /> DO NOT WRITE BELOW THIS LINE. <br /> , <br /> -OPY To GENERATOR WITHIN 30 DAYS: ' <br /> DTIC 8022A (7/92) tj"�,to vho submit hazardow waste for transport out-of,. <br /> EPA 8700-22 p;01-.vce completed copy <br /> of this copy and send to D <br />