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: S <br /> LAWRENCE L IVERMOmE NATIONAL LABORATORY <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM Use Only Page , of J- <br /> 1.Building No: 2. Room No: 3. RMMA: 10.Hazardous D taatir pun»wt` Vold Requisition: <br /> /dd E3Yes OL No Properties <br /> 4.WAA No: 5.W rk lace End Date: 6.Account o' Toxic 12.Outer Container ._,13.Outer Container Size. r " Std <br /> nP�l p 2 - 2 ❑Corrosive1lllt <br /> k OC —4J Type ❑ 1 gal ❑330 gal <br /> ❑ ignitable gal �CM'Skit-IL1N� � <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? o g ❑Box ❑ 5 gal ❑660r <br /> ❑Reactive ❑Can ❑ 7 gal 1--1750 gal <br /> enclal SiiIT <br /> ❑Yes. Activity Codes(enter up to four): W W W W ❑ ❑30 al ❑1000 gal CommVYtfl # <br /> 11.Waste Form: Carboy E-155 gl ❑5000 gal p Sacured pip` <br /> Comments: 9 <br /> a <br /> `�Solid ❑Drum <br /> El 85 gal Ellx1x1.5 it <br /> -_ <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes ❑No EJ Liquid El Tank-Fixed F-12x4x7 ft ❑HWM Field Pump <br /> 8.Profile No: 9.Directorate: ❑Sludge Tank-Portable I/❑44x7 ftp° <br /> ypq� / ❑ al ❑HWM Gene W <br /> H P J� ❑Gas Other: '�� Othe K ❑cu ft ❑Sewisr.: DATE. /_j RSDR#: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. * SAMPLE NO. CODE per tem <br /> pH Normality* amount units <br /> firCOMPLT <br /> BY <br /> For RMMA Waste *Normality Required if pHs 2 or pH a 12.5 AE 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 /> produced 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 /> (If no,full rad analysis required) Generator Name(Print-Last,First): L-Code: Ext.: lhspeded,by,HWM(Print Name-Last,First): Ext.: <br /> 21.Was the waste exposed to particle ,S wmQveu- 52� <br /> beams capable of inducing radioactivity Em to ee No.: Date: Si r�tutb " '` Employee No.: Dater <br /> Signature: P y 9 p Y <br /> by activation? Yes❑ No❑ ZO B4 <br /> (if yes,full rad analysis required) z J <br /> ITEM CrHx RCH P Origin Form EPA No. DISC NO. MSDS N0. Hazardous Properties Handling Code: By: <br /> Code Code <br /> T C 1 R <br /> Date: Loc: <br /> ❑ ❑ ❑ ❑ Chemical Compatibility Code: <br /> ❑ ❑ D Department Generating Waste: <br /> a O ❑ ❑ M A 1: grmture) <br /> Empi No.: Date <br /> ❑ ❑ ❑ ❑ 44ISO-*;L47 <br /> L 5344-8(Rev.3 93) 7600-70302 <br /> White—HWM Copy <br />