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{{#Wiki_filter:COLLECTOR UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST SHIPPING PAPER NRC FORM 540 (MM-YYYY)U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 540  (MM-YYYY)
{{#Wiki_filter: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.
APPROVED BY OMB: NO. 3150-0164 EXPIRES:  (MM/DD/YYYY)
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)
PROCESSOR 7. NRC FORM 540 AND 540A      PAGE 1 OF NRC FORM 541 AND 541A NRC FORM 542 AND 542A ADDITIONAL INFORMATION PAGE(S)PAGE(S)PAGE(S)PAGE(S)ORGANIZATION GENERATOR TYPE (Specify)TELEPHONE NUMBER (Include Area Code)
UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST                                                                                                                                                            NRC FORM 541 AND 541A                                    PAGE(S)
EPA I.D. NUMBER SHIPPING DATE TELEPHONE NUMBER (Include Area Code)
SHIPPING PAPER                                                                                                                                  COLLECTOR                    NRC FORM 542 AND 542A                                    PAGE(S)
: 2. IS THIS AN "EXCLUSIVE USE" SHIPMENT?
PROCESSOR                    ADDITIONAL INFORMATION                                    PAGE(S)
YES 3. TOTAL NUMBER OF PACKAGES IDENTIFIED
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
ON THIS MANIFEST NO YES DATE 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. 
: 9. CONSIGNEE - Name and Facility Address                                    CONTACT (Specify)
 
This also certifies that the materials are classified, packaged, marked, and labeled and are in proper condition for
 
transportation and disposal as described in accordance with the applicable requirements of 10 CFR Parts 20 and 61, or
 
equivalent state regulations.
AUTHORIZED SIGNATURE TITLE DATE  TOTAL PACKAGE ACTIVITY IN SI UNITS TOTAL WEIGHT OR VOLUME (Use appropriate units)
IDENTIFICATION NUMBER OF PACKAGE FOR CONSIGNEE USE ONLY 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  
 
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.
: 1. EMERGENCY TELEPHONE NUMBER (Include Area Code)
: 1. EMERGENCY TELEPHONE NUMBER (Include Area Code)
NO EPA MANIFEST NUMBER
CONTACT TELEPHONE NUMBER (Include Area Code)                                                                                          TELEPHONE NUMBER (Include Area Code)
: 4. DOES EPA REGULATED  
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.
WASTE REQUIRING A  
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  
MANIFEST ACCOMPANY                                                                                               SIGNATURE - Authorized carrier acknowledging waste receipt                    DATE                            AUTHORIZED SIGNATURE                                    TITLE                                                DATE THIS SHIPMENT?
 
NO If "Yes," provide Manifest Number
THIS SHIPMENT?  
: 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)}}
 
If "Yes," provide Manifest Number
: 5. SHIPPER - NAME AND FACILITY USER PERMIT NUMBER SHIPMENT NUMBER CONTACT 6. CARRIER - Name and Address CONTACT SHIPPER I.D. NUMBER TELEPHONE NUMBER (Include Area Code)
DATE 8. MANIFEST NUMBER (Use this number on all continuation pages)
: 9. CONSIGNEE - Name and Facility Address SIGNATURE - Authorized consignee acknowledging waste receipt CONTACT U. S. DEPARTMENT OF TRANSPORTATION DESCRIPTION (Including proper shipping name, hazard class, UN ID number, and any additional information) 12.DOT LABEL "RADIOACTIVE" SIGNATURE - Authorized carrier acknowledging waste receipt
: 13. TRANSPORT INDEX 14.PHYSICAL AND CHEMICAL FORM 15.INDIVIDUAL RADIONUCLIDES 16.17.LSA/SCO CLASS 11.18.19. Instructions: See NUREG/BR-0204 for detailed instructions for completing this form:
http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/}}

Latest revision as of 11:54, 20 October 2019

OMB 3150-0164, NRC Form 540
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)