ML18313A144
| ML18313A144 | |
| Person / Time | |
|---|---|
| Issue date: | 06/26/2019 |
| From: | Lloyd Desotell Division of Decommissioning, Uranium Recovery and Waste Programs |
| To: | |
| L DESOTEL DUWP | |
| Shared Package | |
| ML18313A143 | List: |
| References | |
| OMB 3150-0164 | |
| Download: ML18313A144 (1) | |
Text
APPROVED BY OMB: NO. 3150-0164 Estimated burden per response to comply with this information collection request: 45 minutes. This uniform manifest is required by NRC to meet reporting requirements of Federal and State Agencies for the safe transportation and disposal of low-level waste. Send comments regarding burden EXPIRES: (MM/DD/YYYY) estimate to the Information Services Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0164), 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.
NRC FORM 540 U.S. NUCLEAR REGULATORY COMMISSION 5. SHIPPER - NAME AND FACILITY SHIPPER I.D. NUMBER 7. NRC FORM 540 AND 540A PAGE 1 OF PAGE(S) 8. MANIFEST NUMBER (MM-YYYY) (Use this number on all continuation pages)
UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST NRC FORM 541 AND 541A PAGE(S)
SHIPPING PAPER COLLECTOR NRC FORM 542 AND 542A PAGE(S)
PROCESSOR ADDITIONAL INFORMATION PAGE(S)
Instructions: See NUREG/BR-0204 for detailed instructions for completing this form:
USER PERMIT NUMBER SHIPMENT NUMBER http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/ GENERATOR TYPE
- 9. CONSIGNEE - Name and Facility Address CONTACT (Specify)
- 1. EMERGENCY TELEPHONE NUMBER (Include Area Code)
CONTACT TELEPHONE NUMBER (Include Area Code) TELEPHONE NUMBER (Include Area Code)
ORGANIZATION 6. CARRIER - Name and Address EPA I.D. NUMBER SIGNATURE - Authorized consignee acknowledging waste receipt DATE SHIPPING DATE
- 2. IS THIS AN "EXCLUSIVE USE" SHIPMENT? 3. TOTAL NUMBER OF 10. CERTIFICATION PACKAGES IDENTIFIED This is to certify that the herein-named materials are properly classified, described, packaged, marked, and labeled and YES NO are in proper condition for transportation according to the applicable regulations of the Department of Transportation.
ON THIS MANIFEST TELEPHONE NUMBER CONTACT (Include Area Code) This also certifies that the materials are classified, packaged, marked, and labeled and are in proper condition for EPA MANIFEST NUMBER transportation and disposal as described in accordance with the applicable requirements of 10 CFR Parts 20 and 61, or
- 4. DOES EPA REGULATED WASTE REQUIRING A YES equivalent state regulations.
MANIFEST ACCOMPANY SIGNATURE - Authorized carrier acknowledging waste receipt DATE AUTHORIZED SIGNATURE TITLE DATE THIS SHIPMENT?
NO If "Yes," provide Manifest Number
- 11. U. S. DEPARTMENT OF TRANSPORTATION DESCRIPTION 12. 13. 14. 15. 16. 17. 18. TOTAL WEIGHT 19. IDENTIFICATION DOT LABEL PHYSICAL AND LSA/SCO (Including proper shipping name, hazard class, UN ID number, TRANSPORT INDIVIDUAL RADIONUCLIDES TOTAL PACKAGE OR VOLUME NUMBER OF "RADIOACTIVE" CHEMICAL FORM CLASS and any additional information) INDEX ACTIVITY IN SI UNITS (Use appropriate units) PACKAGE FOR CONSIGNEE USE ONLY NRC FORM 540 (MM-YYYY)