ML18313A144
| 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
COLLECTOR UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST SHIPPING PAPER NRC FORM 540 (MM-YYYY)U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 540 (MM-YYYY)
APPROVED BY OMB: NO. 3150-0164 EXPIRES: (MM/DD/YYYY)
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)
EPA I.D. NUMBER SHIPPING DATE TELEPHONE NUMBER (Include Area Code)
- 2. IS THIS AN "EXCLUSIVE USE" SHIPMENT?
YES 3. TOTAL NUMBER OF PACKAGES IDENTIFIED
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.
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)
NO EPA MANIFEST NUMBER
- 4. DOES EPA REGULATED
WASTE REQUIRING A
MANIFEST ACCOMPANY
THIS SHIPMENT?
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/