NRC Form 542

Estimated burden per response to comply with this information collection reques t: 45 minutes. This uniform manifest is required by NRC to meet reporting requ irements of Federal and State Agencies for the safe transportation and disposal of low-level waste. Send comments regarding burden
estimate to the Records and FOIA/Privacy Service Branch (T-5 F52), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to in [email protected], and to the Desk Officer, Office of Information and Regulato ry Affairs, NEOB-10202, (3150-0166), Office of
Management and Budget, Washington, DC 20503. If a means used to impose an inf ormation collection does not display a currently vaild 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. 3150-0165
EXPIRES: MM/DD/YYYY

NRC FORM 542

U.S. NUCLEAR REGULATORY COMMISSION

1.

UNIFORM LOW-LEVEL RADIOACTIVE
WASTE MANIFEST

2. MANIFEST NUMBER

WASTE COLLECTOR/PROCESSOR

(MM-YYYY)
NAME

SHIPPER USE ONLY

IDENTIFICATION NUMBER
3.

MANIFEST INDEX AND REGIONAL COMPACT TABULATION
List all original "PROCESSED WASTE" generators (if any)
before "COLLECTED WASTE" generators.
4.

5.
GENERATOR
IDENTIFICATION
NUMBER

6.
GENERATOR NAME
PERMIT NUMBER (IF APPLICABLE)
AND TELEPHONE NUMBER

PAGE

SHIPPING DATE

7.
GENERATOR
FACILITY
ADDRESS

8.
PREPROCESSED
WASTE
(OR MATERIAL)
VOLUME
(m3 )

MANIFEST NUMBER(S) UNDER
WHICH WASTE (OR MATERIAL)
RECEIVED AND DATE
OF RECEIPT

9.
WASTE CODE
P = PROCESSED
C = COLLECTED

10.
ORIGINATING
COMPACT
REGION
OR STATE

TOTALS OF ALL PAGES (NRC FORMS 542 AND 542A)
NRC FORM 542 (MM-YYYY)

PRINTED ON RECYCLED PAPER

11.

1

OF

PAGE(S)

AS PROCESSED/COLLECTED TOTAL
A. SOURCE
MATERIAL

B. SNM

C. ACTIVITY

D. VOLUME

(kg)

(g)

(MBq)

(m3 )