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c IAST 1519-Caluk <br /> Stade of t'60omio—Environmental Protection Agency <br /> Fotm A d OMB No.2050 0039(Expires 9-30-94) See Instruction,- on back o' a 6. D pr ment of Toxic Substances Control <br /> Pi print or type. #arm designed for use on elite(12pitch)typewriter. Sacramento,California <br /> 1, Generator's US EPA V lslo. T Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law, <br /> WASTE MANIFEST Ct Al21 81 910 1019 10 10 10 12 3 1 4 1 0 9 1 of <br /> �w <br /> 3. Generator's Name and Mailing Address < <br /> Lawrence Livermore National Laboratory, Site 300 <br /> 7000 East Avenue, Livermore, CA 54550 <br /> C4 4. Generator's Phone (510) 422-1925 Attn: A, Wilt L-620 <br /> 00 <br /> 5. Transporter i Company Name 6. US EPA LD Number <br /> Ereicicson, Inc <br /> r <br /> CAD 0 0 9 4 6 8 3 9 2 <br /> .j 7. 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 /> 00 Z !`RICKSON INC. <br /> L 255 Parr Blvd., Richmond, CA 9 801 <br /> LO <br /> CAD 0 0 9 41 6 6 3 9 2 <br /> U12, Containers 13. total 14. Unit <br /> 0Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Type Quantity Wt/Vol <br /> co S a. <br /> ~ Von RCRA Hazardous Waste, Solid Irmpty Containers Last Containing <br /> 07 3 G Diesel Fvel}(avifh<.1s-4)ciated piping) <br /> 001 TP 08300 P ' <br /> o E <br /> 00 N b. <br /> ao E <br /> N R <br /> A <br /> ®00 e. <br /> I R <br /> Uj <br /> Z d' <br /> w <br /> V I <br /> pn <br /> (w <br /> ...,, _ .FT'd Y dam <br /> v � <br /> tl.1 fice <br /> t . T <br /> � r K c' d <br /> 0 15. Special Handling Instructions and Additional Information <br /> a- <br /> EMERGENCY CONTACT: (510) 4.4 1-uu00C <br /> Z Wear protective clothing while handling These materials are NOT radioactively contaminated. <br /> = HWM RegUisition Number H135905 <br /> t. <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 ore classified, <br /> –d packed,marked,and labeled,and are in all respects in proper condition for transport by highway oecording to applicable federal,state and international laws. <br /> V <br /> If I am a large quantity generator, I certify that 1 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 /> Q 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 /> N <br /> waste management method that is available to me and that I can afford. <br /> ® Printed/Typed Name Signature f Mont <br /> Day Year <br /> r <br /> Richard B Loden on behalf of LLNL 0 3 2 8j2_"4 <br /> V <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> UjN Printed/T Nome Signatur Month Day Yea <br /> 0 �. <br /> Uj 0 11. Tragsiter AckngwIqd9qMjntof Recei t of Materials <br /> q Printed/Typed Name Signatvrm Month Day Year <br /> 0 <br /> R <br /> H 19, Discrepancy Indication Space <br /> IF <br /> 1 20. Facil' Owner or 012erator Certification of receipt of hozardo s materials covered by this monifest except as not d in Item 19. <br /> T Printed/Typed Nome Sigrjo TMonth Day Year 1 <br /> v7,>tvfo l d 4 <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />