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 EXPIRES: (MM/DD/YYYY)
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 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 U.S. NUCLEAR REGULATORY COMMISSION UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST SHIPPING PAPER See NUREG/BR-0204 for detailed instructions for completing this form:
http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/
- 1. Emergency Telephone Number (Include area code)
Organization Yes No
- 2. Is this an "Exclusive Use" Shipment?
Yes No
- 5. Shipper - Name and Facility User Permit Number Shipment Number Contact
- 6. Carrier - Name and Address Contact Signature - Authorized carrier acknowledging waste receipt Shipper ID Number Collector Processor Generator Type (Specify)
Phone No (Include Area Code)
EPA I.D. Number Shipping Date Date Phone No (Include Area Code)
- 7. NRC Form 540 and 540A Page 1 of NRC Form 541 and 541A NRC Form 542 and 542A Additional Information Contact Page(s)
Page(s)
Page(s)
Page(s)
Electronic
- 8. Manifest Number Phone No (Include Area Code)
Date
- 9. Consignee - Name and Facility Address Signature - Authorized consignee acknowledging waste receipt
- 10. CERTIFICATION 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, and equivalent state regulations. For materials that are consigned to a land disposal facility or waste collector, this certifies that 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 and 61, or equivalent state regulations. A collector in signing the certification is certifying that nothing has been done to the collected waste which would invalidate the waste generator's certification.
Authorized Signature and Title Date
- 11. U. S. Department of Transportation Description (Including UN ID number, proper shipping name, hazard class, and any additional information)
- 12. DOT Labels
- 13. Transport Index
- 14. Physical and Chemical Form
- 15. Individual Radionuclides
- 16. Maximum Package Activity in SI Units
- 17. Total Weight or Volume (Use appropriate units)
- 18. Identification Number of Package For Consignee Use Only NRC FORM 540 (MM-YYYY)
- 3. Total Number of packages identified on this manifest?
- 4. Does EPA regulated waste requiring a manifest accompany this shipment?
(If "Yes," provide Manifest Number).
EPA Manifest Number