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t ute or L.o ormo—.nvtronmentaTrroi�fi-onAgency <br /> Form Ap„aroved OMB No.2050-0039(Expires 9-30-94) See Instructions on back of page 6. <.,/ � - <br /> `�D artent of Toxic Coro, <br /> Pleose int or tyfte. torn:^designed for use on elite(12-pi typewriter. *' `? "��iii""" / Sacrament <br /> UNIFORM HAZARDOUS Generator s US EPA ID No. Manifest Docu 2. Page 1 Information in the sh <br /> is not required by Feder w. <br /> WASTE MANIFEST ti of t <br /> 3. Generator's Name and Mailing Address <br /> LOLavrrence Livermore National LaborutQry, Site 300 <br /> 7000 East Avenue, Livermore. CA 94550 <br /> to 4. Generator's Phone (510) 422-1825 Attn: A. Wil, L-620 <br /> OP <br /> O5. Transporter 1 Company Name 6. US EPA ID Number <br /> 0? Ereickson, Inc <br /> tr <br /> J <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number <br /> V <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> CD Z <br /> LO p ERICKSON INC <br /> Ld'? 25.5 Parr Blvd., Rictlrnond, CA 94801 <br /> .;I. U C F, D O 0 3 4 8 8 3 9 2 <br /> W Z 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 /> N t- a. <br /> 3 G Jon HCRA l-?azaraous Wash,Solid j--npty( Ontalners Last Containing <br /> o E Diesel!Fvel)!Wth as:,Ot fated piping <br /> ; 101012 T P 01711 1010 P <br /> ao N b. <br /> co <br /> E ,}' <br /> v R <br /> d A <br /> 0 T c. <br /> O <br /> CX R <br /> W <br /> Z d. <br /> Z <br /> W <br /> U <br /> W <br /> V) <br /> Z <br /> O <br /> a <br /> W <br /> J <br /> Z <br /> Q 15. Special Handling Instructions and Additional Information <br /> Z EMERGENCY CONTACT: (510) 447-6881" <br /> Wear protective clothing while handling "these materials are NOT radioactively contaminated. <br /> W <br /> F <br /> HWM Requisition Numbers 11131464, <br /> J 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q 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 <br /> If I am a large quantity generator, 1 certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> d economically practicable and that 1 have selected the practicable method of treatment,storage, or disposal currently available to me which minimizes the present and future <br /> N threat to human health and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> p�wda�sttey management method that is available to me and that I can afford. <br /> O P1rG}f1Tii a N�7e L QaLCN Div BfNq�F op� Signature Month Day Year <br /> } Oat+ r d L►wre'M w.6-wI rrlf tatf LLM L (�L N` /9 <br /> U T 17. Transporter 1 Acknowledgement of Receipt of Materials V / 7 <br /> W A <br /> N <br /> O A Pri ed yped Name Signatj ��..�i --s-fir ! Mo� ) Day ,yea <br /> (�G �. ! rC f Lr.{ <br /> S I1 f <br /> P � <br /> LLIR 18. Tronsportgr 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Si nature <br /> L- E g Month Day Year <br /> O a <br /> ttL 19. Discrepancy Indication Space • <br /> Q F <br /> U A <br /> Z C C, <br /> I L <br /> 1 1 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest exceot as noted in Item 19 <br /> T Printed/Typed Name -- — — <br /> Y Signature <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 17/92) <br /> EPA 8700-22 ' <br />