ML19095A471

Appendix E, 741 - NRC Form 741_AM_UNC-2017-001

ML19095A471
Person / Time
Site:	07000371 (SNM-0368)
Issue date:	03/01/2018
From:	Cabrera Services
To:	NRC Region 1
Shared Package
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DOE/NRC FORM 741 (10-20'14) Previous editions are obsolete IVIANDATORY DATA COLLECTION AUTHORIZED BY 10 CFR 30, 40, 50, 70, 72,74,75, 150 U. S. DEPARTMENT OF ENERGY AND U. S. NUCLEAR REGULATORY COMMISSION Pu'blic'Laws83-703, 93-438, 95-91 NUCLEAR MATERIAL TRANSACTION REPORT APPROVEDBYOMB: NO.3150-0003 EXPIRES: 10ll1l2017 Eslimatod burdon pot tesponse to comply with this mandaiory collmlion roqueslr t hour and 15 minules. This informalion is roquired Jor IAEA aooounting topoll thai show changes in inventory 01 nuoloar maleilals. Sond commenls rogardlng burden eslimale to ihe FOIA, Ptivacy and lnformation Colleclions Branch (T-5 F53), U.S. Nucleff Regulalory Commission, Washingion, DC 20555-0001, or by inlemel e-mail lo lnfocolltrts.Rosource@nrc,gov, and to the Desk Offcer, OFice of lniomalion and Regulatory Affairs, NEOB-10202, (3150{003), Offce of lllanagmoni and BudgBt, Wa8hinglon, DC 20503, If a m6ans used to impose an informalion oollociion does nol display a outrontly vdid OMB rcnkol numbor, the NRC may nol conducl or sponsor, and a porson is nol.equkod lo respond lo, lhe informalion collolion.

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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 WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WTHIN ITS JURISDICTION.

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