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UST <br /> State of CcAifornio—Environmental Protection Agency �^ ®jq—G`Uj <br /> Form-appr OMB No.2050-0039(Expires 9-30-94) See-.Ir+struetions on back o e 6. � obepartment of Toxic Substances Control <br /> Ploase or type. Form designed for use on elite(12-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDOUS1. Generator's US EPA ID No. Manifest Document No. Page 1 Information in the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFEST d 21 81 2 01 0191010101 2 9 4 0 9 0 of 1 <br /> -01 <br /> 3. Generator's Nome and Mailing Address <br /> Lawrence Livermore National Laboratory, Site 300 � <br /> 4 7000 Bast Avenue, Livermore, CA 94550 �� y <br /> qp¢¢ 4. Generator's Phone (510) 422-1925 Attn: A. Wilt L-820 d <br /> �y 5. Transporter 1 Company Name 6. US EPA ID Num1ber <br /> s°!' Ereicksan, inc <br /> C1 AlDI 01019141 (31 61 31 91 2 <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number , <br /> Q <br /> U <br />�7 9, Designated Facility Name and Site Address 10. US EPA ID Number <br /> ERICKSON INC <br /> "� 255 Parr Blvd., Richmond, CA 94801 C AlDI 01019141616131912 <br /> .�`f <br /> y <br /> �N V 12. Containers 13, Total X14. Unit <br /> 11. US DOT Description(including Proper Shipping Name, Hazard Class,and ID Number) ' <br /> _ No. Type QuantityWt/Yol <br /> c <br /> Z <br /> 00 y a. <br /> S'V� Non RCRA Hazardous Waste, Solid (Empty, Containers Last Containing � <br /> G Oiesel Fuel)(NAOhassociated piping) 0101 1 TP Q '010 P f � <br /> co N b. <br /> 0° E <br /> N R <br /> A <br /> oo <br /> T Q <br /> r V <br /> w <br /> R <br /> Z d. <br /> w <br /> Uj <br /> u <br /> Bove' K handl csd+Rf iATasi <br /> oxygen.content he �'' 1%, d . <br /> ex <br /> 144 <br /> s Cci'ty. Tank# <br /> 0 -45. Special Handling Instructions and Additional Information <br /> ►= EMERGENCY CONTACT: (510) 447-8880 <br /> Z Wear protective clothing while handling These materials are NOT radioactively contaminated. <br /> s HWM Requisition Number H 135903 <br /> .�+ 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of(he consignment are fully and accurately described above by proper shipping name and are classified, <br /> 4 puked,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, I certify that I 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 /> o' threat to human health and the environment;OR, if I am a small quantity generator, I hove made a good faith effort to minimize my waste generation and select the best <br /> v) <br /> waste management method that is available to me and that I can afford. <br /> ® Printed/Typed Nome Signature Month Day Year <br /> r1;Char-1 9 Loden on behalf of LLN1 01 31 21 8 1 9 1 4 <br /> U T 17, Trona orter f Acknowledgement of Recei t of Materials <br /> W a TTy d Nome Signature { Month Day�y Year <br /> a 18. Trona rter 2 Acknowl d ement of Receipt of Materials <br /> i Printed/Typed Nome Signature Month Day Year <br /> �• E <br /> O a <br /> N 19. Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z I <br /> d , <br /> I 20. FocilipLOwner or Ct erotor Certification of recei t of hazardous materials covered by this manifest exce t as noted in Item 19. <br /> T Printed/Typed Name g Signature Month Day Year <br /> Y <br /> -MV/6 a✓t�p ® 3 Z <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-stote, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />