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LAWRENCE LIVERMOnc NATIONAL LABORATORY AGUEPTABLE F00% 693 <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM Use Only Page t of <br /> 1.Building No: 2. Roo No: 3. RMMA: 10.Hazardous Quter Cont it I, Overpackt" sehsduteawasts,RunDate: void Requisition: " <br /> > ❑ Yes No Properties: ❑res ON. J� / / <br /> �—/ <br /> 4.WAA N 5.W rk lace nd Date: 6.Accoun o: >�Toxic <br /> DATE <br /> P 92.Outer Container 13.Outer Container Size: ❑HWM Waste Run Initlals/D <br /> _ Q ❑Corrosive Type: ❑ 1 gal ❑330 gal <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? No ❑Box ❑ 5 gal ❑660 gal ❑Oft-Sete to LLNL RTO y <br /> ❑Reactive <br /> []Yes, Activity Codes(enter up to four): W W M/ W ❑Can ❑30 gal -11000 gal oF1 7 gal El 750 gal <br /> mmerclal"Shipment' yvrD 1" <br /> 11.Waste Form: ❑Carboy ❑55 gal ❑5000 gal ❑Secured Picky <br /> Comments: p <br /> �.Soud ❑�t Drum El 85 gal ❑1x1x1.5 ft <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes No ❑Liquid aTank-Fixed ❑2x4x7 It �'f11NM'Fil PumPO t <br /> ❑Sludge ❑Tank-Portable ❑4x4x7 it 8.Profile No: 9.Directorate: g H <br /> � ❑ WM-Generated Waste. <br /> H P____ <br /> El Other: Otfie <br /> ®•gal <br /> ED cu ft ❑Sewer: DATE:_J_J_RSDR#: <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. H Normality. SAMPLE NO. CODE Per hem <br /> Amount Units <br /> 'FLA 0 <br /> g,i .i fn A s P. (kss 0 C,I C—.\i3!-Ak <br /> n <br /> __.». ...._......_. t <br /> For RMMA Waste *Normality Required if pHs 2 or pH i 12.5 E 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.: (nSp�eed by 1(W Pfint Name Last,First): Ext: <br /> .. <br /> 21.Was the waste exposed to particle " <br /> beams capable of inducing radioactivity Signature: Employee o.: Date: Signature Employee No.: Date: <br /> by activation? Yes El No EDa <br /> (If yes,full rad analysis required) <br /> ITEM RCH RCH P- <br /> Handling Code: B <br /> Code Code" EPA N0. " <br /> Pretax DTSC°tJ�. `,MSDS NO. �� Hazardous Properties Y: <br /> T C I R <br /> Date: Loc: <br /> ❑ ❑ Chemical Compatibility Code: <br /> ❑ ❑ ❑ ❑ Dep rtment Gener ting Waste: <br /> W uisi_ n ro (Sl ture) <br /> oj <br /> �: ,❑ ❑ <br /> �t' ...� �. ❑ ❑ ❑ ❑ E,pl Date: <br /> LL 5344-B(Rev.3/93) 7600-70302 <br /> White—HWM Copy <br /> R <br />