ML22132A240
| ML22132A240 | |
| Person / Time | |
|---|---|
| Issue date: | 07/18/2022 |
| From: | Priya Yadav NRC/NMSS/DDUWP/LLWPB |
| To: | |
| Yadav P | |
| Shared Package | |
| ML22132A233 | List: |
| References | |
| OMB 3150-0164 | |
| Download: ML22132A240 (1) | |
Text
APPROVED BY OMB: NO. 3150-0164 Estimated burden per response to comply with this information collection request: 45 minutes. This uniform manifest or its equivalent is required by NRC to meet reporting requirements of Federal and State Agencies for the safe transportation and disposal of low-level waste (10 CFR 20, App G). Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to EXPIRES: (MM/DD/YYYY) Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0164), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail: oira_submission@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.
NRC FORM 540 5. Shipper - Name and Facility Shipper ID Number 7. NRC Form 540 and 540A Page 1 of Electronic 8. Manifest Number U.S. NUCLEAR REGULATORY COMMISSION Page(s)
NRC Form 541 and 541A Page(s)
UNIFORM LOW-LEVEL RADIOACTIVE Collector Processor NRC Form 542 and 542A Page(s)
WASTE MANIFEST SHIPPING PAPER User Permit Number Shipment Number Page(s) Contact See NUREG/BR-0204 for detailed instructions for completing this form: Generator Type (Specify) Additional Information http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/
- 1. Emergency Telephone Number (Include area code) Contact Phone No (Include Area Code) 9. Consignee - Name and Facility Address Phone No (Include Area Code)
Organization 6. Carrier - Name and Address EPA I.D. Number Signature - Authorized consignee acknowledging waste receipt Date
- 2. Is this an "Exclusive Use" 3. Total Number of packages identified Shipping Date 10. CERTIFICATION Shipment? on this manifest? This is to certify that the herein-named materials are properly classified, described, packaged, marked, and labeled and are in proper condition for transportation according to the applicable regulations of the Department of Transportation, the Commission, Yes No and equivalent state regulations. For materials that are consigned to a land disposal facility or waste collector, this certifies that Contact Phone No (Include Area Code) the materials are classified per the applicable requirements of 10 CFR Part 61, meet the land disposal facility's waste acceptance criteria, and are in proper condition for disposal as described in accordance with the applicable requirements of 10 CFR Parts 20
- 4. Does EPA regulated waste requiring a EPA Manifest Number and 61, or equivalent state regulations. A collector in signing the certification is certifying that nothing has been done to the manifest accompany this shipment? collected waste which would invalidate the waste generator's certification.
(If "Yes," provide Manifest Number).
Signature - Authorized carrier acknowledging waste receipt Date Authorized Signature and Title Date Yes No
- 11. U. S. Department of Transportation Description 17. Total Weight 18. Identification
- 13. Transport 14. Physical and 16. Maximum Package (Including UN ID number, proper shipping name, 12. DOT Labels 15. Individual Radionuclides or Volume Number of Index Chemical Form Activity in SI Units hazard class, and any additional information) (Use appropriate units) Package For Consignee Use Only NRC FORM 540 (MM-YYYY)