ML18269A140
| ML18269A140 | |
| Person / Time | |
|---|---|
| Issue date: | 12/28/2018 |
| From: | NRC/OCIO, NRC/OIP |
| To: | |
| Baker S - 287 9059 | |
| References | |
| Download: ML18269A140 (1) | |
Text
ADVANCED NOTIFICATION OF SHIPMENT OF CATEGORY 1 AND/OR 2 RADIOACTIVE SOURCES In accordance with 10 CFR Part 110.50(c)(3)(ii) of the U.S. NRC Regulations NRC Form 830 (MM-YYYY)
SEND COMPLETED FORM TO:
U.S. Nuclear Regulatory Commission ATTN: Headquarters Operation Center Email: hoo.hoc@nrc.gov (Preferred Reporting Method)
Fax: (301) 816-5151 (Alternative Reporting Method)
A Name of individual and licensee making the notification; address and telephone number:
B Recipient name, location, and address (if different than above):
C Name, location, address, contact name and telephone number for exporting facility:
D Radionuclide(s) and activity level in TBq, both for single and aggregate shipments:
Total Activity Level (TBq):
E Make, model and serial number, for any Category 1 and 2 sealed sources, if available:
F End-use in the U.S.:
G Shipment date from the exporting facility:
(MM/DD/YYYY)
H Estimated arrival date at the end use location:
(MM/DD/YYYY)
NRC or agreement state license number to possess the import in the U.S.:
Expiration date of license: (MM/DD/YYYY)
REPORT OF IMPORT NRC FORM 830 (MM-YYYY) 10 CFR 110.50(c)(3)(ii)
U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0036 EXPIRES: (MM/DD/YYYY)
Estimated burden per response to comply with this mandatory collection request: 30 minutes. This form allows the NRC to request additional information from licensees to determine whether a license should be revoked, suspended, or modified. Send comments regarding burden estimate to the Information Services Branch, (O-1 F21), U.S. Nuclear Regulatory Commission, Washington, DC 20555-001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, 3150-0036, Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
Reference Number:
Comments: