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of eoufar ed Protection Agency <br /> int AppeedOMII No.2050-=9(E.II 9-30-94) i See Instructions an of page 6. Department of Toxic Svilboanon Control <br /> 'Picas.prod of ype. - ro—derpned For um on elks(12rp khJ 7Pe`"rift,, ` Soceamer".California <br /> 1. Generator's US EPA 1D No. Manifest Document No. 2. Pagel Information in the shaded areas <br /> i UNIFORM HAZARDOUS is not requirad by Federal taw. <br /> !WASTE MANIFEST C A 2 18 19_10 10 19 10 10 P 2 9 1 3 0 7 4 of � <br /> 3. Generator's Nome and mailing Address tr" Number, 's <br /> Lawrence Livermore National.Laboratory. Site 300 } yyy '-�: ' ' <br /> ew•.rr .. <br /> 7-922 <br /> Corrall Hollow Road, Tracy, CA 95376 <br /> 4 y 4. Generator's Phone f510 }422-1925 Attn:J. Schreiber L-620 i r <br /> 5. Transporter t Company Name 6. US EPA ID Number Ccn T <br /> f General Industrial lmmkltk)n ""' 3IC <br /> ' <br /> -- — <br /> A Q 0 5 3 9 0 4 7 7 7 ,:�� rCTQ7?746 <br /> –+ 7. Transporter 2 Company Name 8. US EPA ID Number !e er t ,s_I ..• < 4}!14 fi <br /> A ` <br /> FST . e <br /> 4. Designated Facirdy Now and Site Address 10. US EPA ID Number m7s <br /> t�zForward, Inc. - ai,Ig 0'x?' a 4. t 3: 3, ,`:ts <br /> 7LL. 9999 S Austin Roast. Manteca. CA 95338 A f� �h y�� � <br /> 9 A D 9 ® 7 4 3 ;ftr' Lµ 09}:982-429$ ° <br /> Contai4. '• *."• <br /> 0z 11. US DOT Description(including Proper Shipping Name,Nozard Clan,and 10 Number) 12. ners 13. Total 14. Unit <br /> —Na. aimlilty wtiv., <br /> AQ Hazardous Substance, Solid, n.o.s.,ORM-E, NA 9188 <br /> n G (Asbestus) (DOT ERG#31) Y et+A/t3tber <br /> 4, <br /> OD N b. State n s� s <br /> C41 R <br /> T <br /> P O <br /> � R EI•AjQlhn'-�" <br /> •epA/�.p9y .R <br /> J. Additional descriptions for materials Usted Abe"-`:` '' 4 K.141p" for Wastes Weed Abe" <br /> �. EMERGENCY CONTACT: M.N. Hayek, (510)447-6880 a.� �� b. <br /> uj <br /> J <br /> J C. d. <br /> Q <br /> z <br /> O 15. Special Nandfmp Instruction and Additional information <br /> P Wear proper respirat x equipment and protective clothing. Do not Leak bads, avoid breathing dust <br /> z <br /> 9-: These materials are NOT radioactively contaminated. <br /> J 16. GOMATt?It'S CERTIFICATION: I hereby declare that Ibe contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Upocked,marked,and labeled,and are in all respects In proper condition for transport by highway according to applicable federal,slate and International laws, <br /> If I am a large quantity generolor, I certify that I have a program in place to reduce the volume and totleiy of waste generated to the degree 1 have determined to be <br /> economically prockoble and that I have selected the prookable method of treatment,storage di urrantly available to me whkh minimises tine present and future <br /> threat to human health and the environment;OR,if 1 am a small quantity generator, t have a ood ith effort o minimks my waste generation c select the best <br /> waste masa of me*od that is available to me and that I can afford. IL <br /> O Printed/Typed NameSignature r ear <br /> Michael N. Hayes on behalf of LLNL <br /> Z T 17. Tran er 1 Aeknovded tment of Receipt of materials <br /> U, w /TY 1 Month Day Year <br /> 09 fZ ✓i r 2, On <br /> O TO, Transporter 2 AAMyyf!OOgeme nt of R pt.o <br /> T Printed/Typed Name StgnaNre Month Day Year <br /> e <br /> u� 19. Discrepancy Indkalion Space <br /> V is <br /> Z C <br /> _ t <br /> ! ` <br /> I 20. Foci' Owner or operator Certsfkofion of receipt of houardous materials covered by this jI ePI as no let Item 14 <br /> T Pr T ed Name ` Month Day Year <br /> DO NOT WRITE BELOW THIS UNE. <br /> wlul.:•: ISM :&NDS nils COPY TO DTSC WfiftlN 11 DAYS. <br /> uTSC 8022A ft2/41) P o Ro. 10(Y) '..,.......�„:.. CA 95R17 <br />