ML19095A464

Appendix E, 741 - NRC Form 741_AA_ZBV_VDM_Transaction_4 08282017

ML19095A464
Person / Time
Site:	07000371
Issue date:	03/01/2018
From:	Cabrera Services
To:	NRC Region 1
Shared Package
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References
Download: ML19095A464 (1)

Text

DOE/NRC FORM 741

('10-2014) Previous editions are obsolete MANDATORY DATA COLLECTION AUTHORIZED BY 10 CFR 30. 40, 50, 70, 72,74,75,150 Public Laws83-703, 93-438, 95-91 U. S. DEPARTMENTOF ENERGY AND U, S. NUCLEAR REGULATORY COMIIISSION NUCLEAR MATERIAL TRANSACTION REPORT APPROVEDBYOMB: NO.3l50-0003 EXPIRES: 10131t2017 Eslimal6d burdsn pr respons to comply wiih this mandaiory coll@lio rqueslr t hour and 15 minulos. lhis inlormation is required lor lAEl a@ounling ropdlslhal show ohangB in invenlory of nudod malerialG. Send mmMls rBgarding burdon eslimalo lo the FOIA, Ptivacy an(

lnhmaliil Collections granch (T-5 F53), U.S. Nudoar Rsgulatory Commi$im, Washinglm, DC 20555{001, or by inhrnel mail k InfoDolhcls.Resouroe@nrc,gov, md lo lho Desk Officer. Offi@ of lnformalion dd Regulalory Affairs. NEOB-10202, {3150-0003), Office o Maf,agomonl af,d Budgei, Washinglon, DC 20503, 11 a moans used to imposo an lnformation coll@lion does nol display a curontly vali(

OlllB control number, th6 NRC may nol conducl o. Eponsor, and a person is nol required lo rspond lo, lhB inlomalion oolleolion, l.6FrppERsRts l 2.qEcEtvER'sRts

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WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U,S.C. SECTION 1OO1 MAKES IT A CRIMINAL OFFENSE TO MAKE A WLLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WTHIN ITS JURISDICTION.

DOE/NRC FORM 741 l1O-2O14\\