NUREG/BR-0204, Rev, 2, Instructions for Completing NRC's Uniform Low-Level Radioactive Waste Manifest

U
NT:

F-

'-T

TP!.5

is>..

F~~

A

,

I_-t

.,

S

CAOLS

CNC'-

9. NF.$

ME

..

~~P
-AD J

's

Instructions for-CompletingNRC's••
Uniform Low-Level Radioactive
-

AG

Gop.

" ,3vC-~A'
-AP

'Y

~~o
r.'

~ t A Q-:7V E

.'

Waste ManifeSt

7-7

.I

1

'04 1,

ý

C,
Sic

F~;
R
4 LO.LVSL
WASIOCTIVE
Afl IV T ~~
WAT ANIFEST-

u

As-'
td%3

c
-

~

SNUC±XAR LGu
''Sn----

CL

-a

ASTpS

r CMM
ropy

-LOWVELIRADIOACTIVE
WASTE MANrr:Pz-r

~'T

U.S. Nuclear
Regulatory
R

UNIFORM LOW.LEVEL,

WASTE MANIF

NRegulatry041

CNAINE-D WASTEOERpj

MY
kr.-

INSTRUCTIONS FOR COMPLETING
NRC'S LOW-LEVEL RADIOACTIVE
WASTE MANIFEST
LISTED IN THESE INSTRUCTIONS ARE THE ITEMS OF
INFORMATION THAT ARE FEDERALLY REQUIRED OR
OTHERWISE NEEDED FOR THE COMPLETION OF THE
UNIFORM Low-LEVEL RADIOACTIVE WASTE MANIFEST
(NRC FORMS 540, 541, AND 542). AN EXPLANATION OR
REFERENCE FOR EACH ITEM IS INCLUDED TO ASSIST YOU IN
PROPERLY COMPLETING EACH FORM. PLEASE CALL THE
DESIGNATED CONSIGNEE, THE U.S. NUCLEAR
REGULATORY COMMISSION (301-415-6196), OR THE U.S.
DEPARTMENT OF TRANSPORTATION (202-366-4488) IF
YOU SHOULD NEED CLARIFICATION OF ANY OF THE ITEMS.
OBTAIN COPIES OF NRC's UNIFORM LoW-LEVEL
RADIOACTIVE WASTE MANIFEST FORMS AND THE GENERAL
INSTRUCTIONS FROM THE GRAPHICS AND ELECTRONIC
COMPOSITION SECTION OF THE PUBLISHING SERVICES
BRANCH, MAIL STOP T-4 E16, U. S. NUCLEAR
REGULATORY COMMISSION, WASHINGTON, DC 205550001 OR TELEPHONE 301-415-5877 OR E-MAIL ADDRESS
.

SAMPLE NRC FORMS 540, 541, AND 542 ARE SHOWN AS
EXHIBITS AT THE END OF THESE INSTRUCTIONS.
THE ONLY CHANGES BETWEEN REV. 2 AND REV. 1 OF
THESE INSTRUCTIONS ARE (1) UPDATED INFORMATION FOR
REQUESTING FORMS AND INSTRUCTIONS, (2) UPDATED
SAMPLE FORMS THAT SHOW THE CURRENT OFFICE OF
MANAGEMENT AND BUDGET CLEARANCE NUMBER AND
(3) A MINOR CLARIFICATION TO THE CERTIFICATION

STATEMENT ON NRC FORM 540.

NUREG/BR-0204, Rev. 2

The Uniform Low-Level Radioactive Waste Manifest
consists of the following forms:

Compact manifesting requirements may encompass
shipments beyond those defined by the NRC.

(1)

NRC Form 540 and 540A': Uniform LowLevel Radioactive Waste Manifest (Shipping
Paper) and continuation page;

NRC Form 540 is to be completed by specified shippers of
low-level radioactive waste intended for ultimate disposal at
a licensed land disposal facility.

(2)

NRC Form 541 and 541A: Uniform Low-Level
Radioactive Waste Manifest (Container and
Waste Description) and continuation page; and

(3)

NRC Form 542 and 542A: Uniform Low-Level
Radioactive Waste Manifest (Manifest Index &
Regional Compact Tabulation) and
continuation page.

NRC Form 541 is to be completed by specified shippers of
low-level radioactive waste intended for ultimate disposal at
a licensed land disposal facility, unless agreement has been
reached between appropriate parties to transmit the required
information electronically.

The entities who must comply with manifesting regulations
are defined in Appendix G, Section I, to 10 CFR Part 20.
Typically, all shipments of low-level radioactive waste for
which the consignee is a licensed low-level radioactive
waste disposal facility are subject to NRC manifesting
requirements.
With exceptions as defined in the regulations, shipments of
low-level radioactive waste (as determined by the consignor
within the definitions in the regulation) to waste processors
or waste collectors, prior to ultimate disposal of the
radioactivity at a licensed disposal facility, are also subject
to these manifesting requirements. Note that State or

'Forms 540 and 540A and their respective
instructions are based on Department of Transportation
regulations, including changes issued on September 28,
1995 (60 FR 50292).
NUREG/BR-0204, Rev. 2

2

NRC Form 542 should be completed by processors and
collectors of low-level radioactive waste who are shipping
low-level radioactive waste attributed to others for ultimate
disposal at a licensed land disposal facility, unless
agreement has been reached between appropriate parties to
transmit the required information electronically.
Note: The NRC requires all users of the Uniform Manifest
forms to report information in metric units, and all the forms
have been developed for the use of metric units. Metric
units are used in NRC Form 540 as permitted by DOT
regulations, and required after April 1, 1997, with the
exception of Item 18 (Total Weight or Volume) in which
DOT allows the shipper to specify appropriate units. DOT
allows reporting of English units following the International
System of Units (SI). NRC Forms 541 and 542 are
designed for metric reporting. However, if the consignor,
consignee, and others having authority over reporting
requirements agree, metric and English units may be used.
In this case, the shipper may need to add the English units to
the forms in a manner that prevents misinterpretation.

3

NUREG/BR-0204, Rev. 2

Note: Information in these instructions that is typed in
italics is not required by Federal law or regulation.
Radioactive shipments that are not manifested under NRC
regulations must continue to comply wýith Department of
Transportation (DOT) regulations.

NRC FORM 540: UNIFORM

LOW-LEVEL RADIOACTIVE WASTE MANIFEST
(Shipping Paper)
NRC Form 540 must be completed for shipments of lowlevel radioactive waste intended for ultimate disposal at a
licensed land disposal facility. The majority of the.
information on NRC Form 540 is needed to meet DOT
shipping paper requirements for radioactive, material
shipments. The following are general instructions. Details
regarding DOT requirements can be found in 49 CFR Part
172.
1.

Emergency Telephone Number -The shipper is to
provide an emergency response telephone number or
numbers for use in the event of an emergency. If a
single number applies to every entry on the shipping
papers, enter this number in the space provided. If
there are multiple numbers, each individual number
must be entered in Item 11 immediately following the
applicable description of the radioactive material.
Enter the name of the organizationresponsiblefor
providing the emergency response information.

Note that additional emergency response information
must be available and-presented in accordance with 49
CFR 172.602.
2.

NUREG/BR-0204, Rev. 2

4

Is This an "Exclusive Use" Shipment? - The
shipper answers by checking "yes" or "no." See 49
CFR 172.203. If "yes," then specific instructions for
maintenance of exclusive use shipment controls must
be provided by the shipper to the carrier and must be
included with the shipping paper as required at 49
CFR 173.403.

5

NUREG/BR-b204, Rev. 2

3.

Total Number of PackagesIdentified On This
Manifest - Indicate the total number ofpackages
listed on this manifest.

4.

Does EPA Regulated Waste Requiring a Manifest
Accompany This Shipment? - If the answer to this
question is "Yes," the shipper completes the
applicable EPA manifest and attaches it to the NRC
Form 540. The shippershould also identify the EPA
manifest number in the spaceprovided (ifacceptable
to the consignee, the manifest number appearingin
Item 8 ofNRC Form 540 may be identical to the EPA
manifest number).

5.

Shipper - Indicate the combpany or facility name,
facility address, contactperson, and telephone
number. If applicable, indicate the permit or other
similar number assignedto the shipper by the
appropriatehost State in which the designated
licensed disposalfacility is located. Indicate whether
the shipper is a waste generator, collector, or
processor, as defined in the regulation, by checking
the appropriate box. Ifyou are a generator,enter one
of the following letter codes (Government - G, Fuel
Cycle Industry - FC,Nuclear Power - NP, University
(Academic) - A, Medical - M, Industrial- I, Other - 0)
in the "GENERATOR TYPE"space. The space for a
'shipperidentificationnumber is providedfor the
shipper to recordthe number, if any, assignedto the
shipper by the consignee or the designated disposal
facility operator. A space provided under the
heading, "SHIPMENT NUMBER," is for any use
deemed appropriateby the shipper.

NUREG/BR-0204, Rev. 2

6

6.

Carrier - Indicate either the carrier's name, address,
contact person, and telephone number, or the carrier's
name and EPA identification number. Also include
the shipping date. Upon receipt of the shipment, an
authorizedcarrierrepresentative will acknowledge
shipment receipt by signing and dating in the space
provided.

7.

Enter the total number of pages for EACH set of
NRC Forms (i.e., Forms 540 and 540A, Forms 541
and 541A, and Forms 542 and 542A). In addition,
identify the number ofpages of additionalinformation
(e.g., host State) that requiresa separatepage or
pages and is apartof this manifest. Ifan EPA
manifest accompanies the NRC Forms, do not include
its pages in Item 7.
IfNRC Form 542 or additionalpages are not part of
this manifest, enter "None" in the appropriateblank.
If only NRC Form 540 (and 540A, if necessary) is
intended to physically accompany the shipment (e.g.,
the shipper is electronically or otherwise providing
NRC Forms 541 and 542 and any additional
information separately to the consignee), then this
must be indicated by placing parentheses around the
number of pages entered for NRC Forms 541, 542,
and additionalinformation.

8.

Manifest Number - A traceable manifest number of
at least four number/letter characters must be entered
by the shipper. This number may be dictated by the
consignee of the low-level radioactive waste (e.g., the

7

NUREG/BR-0204, Rev. 2

waste processor, waste collector, or licensed disposal
site operator) prior to the shipment.
9.

10.

11.

12.

Consignee - Indicate the company or facility name,
address, contact person, and telephone number. Upon
receipt of the shipment, an authorized person at the
facility will acknowledge receipt of the shipment by
signing and dating in the space provided.
Certification - The certification on the manifest must
be signed and dated by the person responsible for the
packaging and labeling operations. The person must
also be authorized to sign on the behalf of the
shipping company or facility.
U.S. Department of Transportation Description
(Including Proper Shipping Name, Hazard Class,
UN ID Number, and Any Additional Information)
- The requirement for providing this information is
contained within DOT regulations at 49 CFR 172.202.
For purposes of transportation in commerce, DOT
regulations at 49 CFR 172.101 provide a listing of
hazardous materials. If this information is required,
the shipper must use the exact descriptors, in the order
specified, in the DOT regulations. Additional
description requirements (e.g., indication of
Reportable Quantity and NRC Certificate-of
Compliance, if applicable) are specified at 49 CFR
172.203.
DOT "Radioactive" Label - See DOT regulations at
49 CFR 172.203 and 49 CFR 172.403. Indicate the
type of radioactive label that appears on the package
(White - I, Yellow II, or Yellow III). The shipper
does not need to repeat the word "RADIOACTIVE."

NUREG/BR-0204, Rev. 2

8

If no label is required by DOT, place "NA" in this
column.
13.

Transport Index - See DOT regulations at 49 CFR

173.403. This is a dimensionless number, which, for
nonfissile material packages, is equivalent to the
radiation dose rate in millirem per hour at one meter
from the surface of the package. The Transport Index
is placed on the label of a package to designate the
degree of control necessary during transportation. If
reporting of the Transport Index is not required, place
"NA" in this column.
14.

Physical and Chemical Form - See DOT regulations

at 49 CFR 172.203. Describe the physical form of the
contents of the package as "Solid," "Liquid," or
"Gas." List the most prevalent chemical form, e.g.,
cellulose, cement, metallic oxides. Additional
generic information on material description may be
included, as needed, to satisfy requirements of
shipment consignee. Further information on the
physical and chemical description of the waste is
required on NRC
Form 541.
15.

Individual Radionuclides - See DOT regulations at

49 CFR 172.203 and official abbreviations at 49 CFR
173.435. List the radionuclides (as determined in
DOT regulations at 173.433(f)) that are present in the
transport package. The element symbol may be
immediately followed by the nuclide's mass number,
i.e., a dash is not needed. A semicolon and space
should separate the listing of multiple nuclides.

9

NUREG/BR-0204, Rev. 2

16.

Total Package Activity in SI Units -Report the total

activity in the transport package in SI units (e.g.,
megabecquerels). If desired, this activity may also be
reported in units of millicuries, in parentheses below
the listing in SI units.
17.

LSA/SCO Class - See DOT Regulations at 49 CFR

172.203. For a shipment of low specific activity
material or surface contaminated objects, provide the
appropriate group notation.
18.

Total Weight or Volume - See DOT regulations at
49 CFR 172.202. Using the most appropriate units,
identify the total weight or total volume (net or gross
as appropriate) of the material identified in Item 11..

19.

IdentificationNumber of Package - For each
package, a package identification number, unique
among the individualpackage identificationnumbers
within the shipment, should be provided Both
numbers and letters may be used.

DO NOT WRITE IN THE AREA LABELED "FOR
CONSIGNEE USE ONLY." THIS AREA HAS BEEN LEFT
BLANK INTENTIONALLY TO ALLOW EACH DISPOSAL
FACILITY TO RECORD DISCREPANCIES, BURIAL
INFORMATION, ETC. (THE INFORMATION INTHIS SPACE
ISTO BE DETERMINED BY THE INDIVIDUAL
CONSIGNEES.)
Use NRC Form 540A if additional space is needed to
describe this shipment. Indicate the page number, total
Form 540 and 540A pages, and the manifest number
reported in Item 8.
NUREG/BR-0204, Rev. 2

10

NRC FORM 541: UNIFORM
LOW-LEVEL RADIOACTIVE WASTE MANIFEST
(Container and Waste Description)
This form must be completed by shippers of low-level
radioactive waste as defined on pages 2 and 3, unless the
information is being transmitted electronically, as noted on
page 3 of these instructions.
If waste shipments are to a consignee other than the disposal
facility operator or are uncontainerized, not all the
information is required by NRC regulations. For shipments
of containerized waste to a consignee other than the disposal
facility operator, the information requested under Items 5
through 10 of "DISPOSAL CONTAINER
DESCRIPTION" and Item 16, "Waste Classification," is
not required by NRC regulations. (Note that container
information, however, may be required by the consignee.)
For all shipments of uncontainerized waste, Items 5, 6, and
10 are not applicable; the volume of the waste would be
reported in Item 7, the weight of the waste in Item 8, and
surface radiation levels in Item 9. For those uncontainerized
wastes shipped to a consignee other than the disposal
facility operator, the information requested in Items 9 and
16 is also not required by NRC regulations.
1.

Manifest Totals - Indicate the total number of lowlevel waste disposal containers described on this
manifest (the total number ofpackages may be listed,
if the consignee is not a licensed low-level waste
disposalfacility), the total net waste volume (cubic
meters), and the total net weight (kilograms).
Appendix G of 10 CFR Part 20 requires separate

II

NUREG/BR-0204, Rev. 2

manifest totals for tritium (H-3), C-14, Tc-99, 1-129, U-233,
U-235, plutonium, and uranium and thorium in source
material. For the first four nuclides, enter, the totals in
megabecquerels (MBq) in the appropriate boxes. If the
radionuclides are not present, place "NP" in the appropriate
space. If the radionuclides are present in any of the
containers within a shipment, but are identified in Item 15 in
quantities no greater than the lower limit of detection
(LLD), the quantities of these nuclides must be recorded as
the sum of the respective LLD values (with the summed
value included in parentheses). (Note that Item 15,
beginning on page 18, would also be expanded to reflect the
reporting of tritium (H-3), C-14, Tc-99, and 1-129 below
LLDs). If both detectable and quantities based on LLD
values of radionuclides exist in containers making up a
shipment, the sum of the detectable and "LLD-based" values
must be reported separately, the latter in parentheses. The
total activity for all nuclides on the manifest (excluding
LLD values) must be indicated in the "ALL NUCLIDES"
column.
Also indicate the total manifested quantity of uranium and
thorium in source material (kilograms) and special nuclear
material (grams), including uranium and thorium in
unimportant quantities defined in 10 CFR 40.13. Note: The
mass being requested is not the weight of the waste
containing these nuclides. Ensure that the totals in grams
for U-233, U-235, and plutonium equal the grand total of the
weight of these nuclides in Special Nuclear Material.
Indicate the total number of disposalcontainerscontaining

NUREG/BR-0204, Rev. 2

12

each type of Special Nuclear Materialin parenthesis
after the quantity listing.

2.

Manifest Number - Transfer the manifest number
from NRC Form 540, Item 8.

3.

Page 1 of__
page(s) - Include the total number of
Form 541 and 541A pages.

4.

Shipper Name and ID Number - Same as reported in

Item 5 of NRC Form 540.
NOTE: SEE PREVIOUS DISCUSSION
REGARDING THE COMPLETION OF ITEMS 5
THROUGH 10 ON FORM 541.
5.

Container Identification Number/Generator ID
Number(s) - Provide a disposal container

identification number unique among the individual
container identification numbers within the shipment
(both numbers and letters may be used). Also indicate
ID number(s) of the generator(s) contributing waste to
the disposal container. If more than one disposal
container is assigned to a single generator, the
generator ID number need not be repeated. Note that
the definition of "generator" identified in this item
includes (a) "waste generators" as defined in
Appendix G of 10 CFR Part 20 and (b) those
licensees to which waste can be reasonably attributed,
in the context of the Low-Level Radioactive Waste
Policy Amendments Act of 1985, as a result of
processing, decontamination, or transfers of
radioactive materials.

13

NUREG/BR-0204, Rev. 2

The spacing between the vertical listings of generator
ID numbers in this column (if more than one
generator contributes waste to a single disposal
container) allows for the recording, on an individual
generator basis, of all information required under the
heading, "Waste Description for Each Waste Type in
Container." Note that information on discrete waste
types (i.e., activated material, contaminated
equipment, mechanical filter, or sealed source/device
wastes or individual disposal container wastes
contained in different solidification/stabilization

7.

Volume (Cubic Meters) - As a minimum, indicate
the volume of the outside dimensions of each
container to the nearest hundredth of a cubic meter.
Consignees (e.g., disposalfacility operators)may
require a greatersensitivity of measurement. For
volumes of less than 1 cubic meter, always include a
zero in front of the decimal. For bulk unpackaged
waste or unpackaged components or equipment, enter
the estimated volume of the waste.

8.

Waste and Container Weight (Kilograms) - List the
combined weight, in kilograms, of the container plus
the contents. For uncontainerized waste, provide the
weight of the waste. Consignees may requirespecific
sensitivities of measurement.

9.

Surface Radiation Level (jiSv/hr or mSv/hr) Indicate the radiation level on contact with the
disposal container or uncontainerized waste. If this
level does not represent the highest radiation level on
the disposal container, provide additional descriptive
information. Select appropriate units for the entire
page. Do not use "BKG" for background levels
unless the background level is indicated in this
column.

10.

Surface Contamination(MBqIDO0 cm2):
Alpha, Beta-Gamma - Record the results of
contaminationsurveys performed on the disposal
container. Do not use "BKG"forbackground levels
unless the backgroundlevel is indicatedin this
column. Estimated values are acceptable ifpotential
occupationalexposures limit survey data collection.

media) is requested. No more than one generator
should be listedper outlined row. Individual
consignees (e.g., disposalfacility operators)may
require more extensive breakdowns of radiological
descriptions (e.g., for Class AS or A U waste).

6.

Container Description - Using the codes found in
Note 1 at the bottom of NRC Form 541, describe the
disposal container. When Code 13 (High Integrity
Container) is used, also identify the manufacturer and
the model number. NRC and/or host State Certificate
of Compliance Number(s) should be identified, as
appropriate. If Code 19, "Other," is used, describe the
container in Item 6. If the explanation is not entered
in Item 6 (the preferred method), enter "see additional
page" and provide the description on that page. The
additional page must be included in the "additional
information" total pages called for in Item 7 of NRC
Form 540. If the container and waste require disposal
in an approved structural overpack, the letters "-OP"
must be entered following the appropriate code
number.

NUREG/BR-0204, Rev. 2

14

15

NUREG/13R-0204, Rev. 2

11.

12.

Waste Descriptor - Using the codes found in Note 2
at the bottom of NRC Form 541, indicate the codes
that most specifically describe the type of waste in the
container. For discrete waste types (i.e., activated
material, contaminated equipment, mechanical filter,
sealed source/device or for wastes contained in
different solidification/stabilization media), the
spacing between these vertical listings of waste
descriptors or medias (if more than one waste type or
media is included in a single disposal container)
allows for the provision of radiological descriptions
on an individual waste descriptor and individual
solidification/stabilization media basis. Individual
consignees (e.g., disposalfacility operators)may
requiremore extensive breakdowns of radiological
descriptions. If Code 59, "Other," is used, a written
explanation is required. The preferred option is to
include the explanation in Item 11, but if additional
space is required, enter "see additional page" in Item
11. The additional page must be included in the
"additional information" total pages called for
in
Item 7 of NRC Form 540.
Approximate Waste Volume(s) in Container Indicate the approximate volume in cubic meters of
containerized waste, as applicable, by generator,
waste descriptor (if activated material, contaminated
equipment, mechanical filter, or sealed source/device
waste or waste contained in different
solidification/stabilization media). ">85%" may be
entered if (1) the disposal container "fill volume"
exceeds 85%; (2) the disposal container does not
contain the aforementioned discrete wastes, together
or mixed with other waste types, and does not contain

NUREG/BR-0204, Rev. 2

16

more than one solidification/stabilization media; and
(3) the external volume reported in Item 7 is
approximately equal to the internal disposal container
volume.
•13.

Sorbent, Solidification, Stabilization Media - All
shipments must use the codes found in Note 3 at the
bottom of NRC Form 541. Indicate the code(s) that
identifies the material used to solidify or absorb waste
material. The spacing between the vertical listings of
media descriptors (if more than one media descriptor
is included in a single disposal container) allows for
the provision of radiological descriptions on an
individual "media-descriptor" basis. Individual
consignees may require more extensive breakdowns of
radiologicaldescriptions. Similarly, individual
disposalfacilities may requiresolidification of certain
wastes (e.g., oil) in specified media and may require
identification of media vendor (manufacturer)and

brandname. If Code 89 or 99, "Other," is used, a
written explanation is required. The preferred option
is to include the explanation in Item 13, but if
additional space is required, enter "see additional
page" in Item 13. The additional page must be
included in the "additional information" total pages
called for in Item 7 of NRC Form 540.
If the solidification process is intended to stabilize the
waste in accordance with applicable NRC regulations
at 10 CFR 61.56(b) and disposal site requirements, a
letter, "-S", must be entered following the appropriate
code number. Note that all Class B and C wastes
must meet stability requirements. For all wastes
claimed to meet the aforementioned stability

17

NUREG/BR-0204, Rev. 2

requirements, the vendor (manufacturer) and the brand
name of the solidification media must be identified in this
column.
14.

Chemical Description - List the most prevalent
chemical forms of the waste. Information in Item 14
should expand upon the chemical form description in
Item 14 of NRC Form 540. If animal carcasses were
coded in Item 11, the chemical form should include
the word "LIME," if applicable, in addition to any
other significant chemicals. Also indicate the name of
the chelating agents that are present in amounts
greater than 0.1% by weight of waste. Specify the
percent in the column under the heading "Weight %
Chelating Agent if >0.1 %." If chelating agents are
not present indicate "NP." If chelating agents
represent less than 0.1% by weight, indicate "0." If
wastes were generated from large decontamination
processes (e.g., LOMI, Can-Decon, .Citrox, etc.),
indicate the process in this column. If an additional
sheet describing the content of these wastes is needed,
note this in Item 7 of NRC Form 540.

15.

Radiological Description - This information may be
presented in either of two ways. First, list all
significant radionuclides followed by their respective
activities in megabequerels that are present in the
waste in each container and for each waste generator
(e.g., if waste from more than one generator is
contained in a single container). Daughter products
must be either individually reported or, if within a
factor of 2 of being in equilibrium with its (their)
parent, reported as the parent with its activity listed,
but with the symbol "D" or "NAT" indicating

NUREGIBR-0204, Rev. 2

18

daughter products in equilibrium (e.g., Cs-137D or
ThNAT). For waste included within a single
container, the significant radionuclides and'their
respective activities must be separately reported for
discrete waste types (i.e., activated materials,
contaminated equipment, mechanical filters, and
sealed source/devices and wastes in
solidification/stabilization media). Other wastes may
be described by a combination of waste descriptor
codes and, as a result, the radionuclides and activities
may be reported as a combined total. When the
radionuclides tritium (H-3), C-14, Tc-99, or 1-129 are
present, but the quantities are below the LLD, note the
radionuclide and report the LLD value in parentheses.
After listing the individual radionuclides as described
above, enter the word "Total" on a new line and enter
the total activity contained in the container. However,
if any LLD values were included in the container,
these values should not be included in the container
sum because they will be totaled separately under
Item 1.
OR, alternatively, for containers containing a single
waste type, enter the total megabequerels in the
container (for each waste generator, if waste from
more than one generator is included in a single
container) and enter the percent of each radionuclide.
Always include the "%" sign when using this option.
Individual consignees may require more extensive
breakdowns ofradiologicaldescriptionsor may not
allow the alternative method of reportingdescribed
above.

19

NUREG/BR-0204, Rev. 2

Note: The activity for uranium and thorium in source
material and U-233, U-235, and plutonium in Special
Nuclear Material must be reported in megabecquerels.
The quantity of these isotopes must be reported, in
kilograms for source material - including the
abbreviation "kg", and in grams for Special Nuclear
Material - including the abbreviation "g." The
weight quantities must be reported in brackets, either
adjacent to the activity listing or below the
radionuclide listing.
A radionuclide is "significant" if it is contained in the
waste in concentrations greater than 0.01 times the
concentration of that nuclide listed in Table 1 of 10
CFR 61.55 or 0.01 times the smallest concentration of
that nuclide listed in Table 2 of 10 CFR 61.55. A
radionuclide other than one listed in the tables is
considered significant if it is contained in the waste in
concentrations greater than 0.26 megabecquerels/cm 3 .
Furthermore, any radionuclide whose activity
represents a Reportable Quantity under DOT
regulations or is 0.01 or'more of the total activity
within the disposal container should be listed even if
the above concentration criteria are not exceeded.
Listing only the most abundant radionuclides or the
category "mixed fission products" is not acceptable.
Use official abbreviations only.
To save space, two nuclides and their respective
activities may be entered on each line in this bisected
column. Additional nuclides and their respective
activities may be entered on subsequent lines that may
be included in each "outlined"row; that is, the lines
separatingrows are not intended to limit the vertical
NUREG/BR-0204, Rev. 2

20

reporting of nuclides and activities, but areprovided
to aid the transcriptionand readabilityof the.
provided information.
16.

4

Waste Classification - Using the following codes,
indicate waste classification and the structural
stability of the waste in accordance with applicable
NRC requirements or the radioactive material license
applicable at the disposal facility to which the waste
will be consigned. Waste generators shipping to
processors need not complete this item.
AS - Class A Stable
AU - Class A Unstable
B - Class B
C- Class C
BU or CU (unstable class B or C) may be used
to classify waste requiring appropriate handling
or processing at a disposal facility to achieve
required stability. If Greater-than-Class C
wastes are shipped, use "GTCC" (see 10 CFR
61.7(b)(5)).

Use NRC Form 541 A if additional space is needed to
describe this shipment. Indicate the page number, total
number of Form 541 and 541A pages, and the.manifest
number from NRC Form 540, Item 8.

1

21

NUREG/BR-0204, Rev. 2

NRC FORM 542: UNIFORM
LOW-LEVEL RADIOACTIVE WASTE MANIFEST
(Manifest Index and Regional Compact Tabulation)
1.

Waste Collector/Processor- Complete the collector
orprocessor's'name,ID number, and the shipping
date. Space has also been providedfor any use
deemed appropriateby the shipper.
A waste collector or processoris an entity, operating
under a Commission or Agreement State license,
whose principalpurposefor possessing the
radioactive materialor waste is asfollows:
a

A collector collects and consolidates waste
generatedby others and transfersthis waste,
without processingor.repackaging,to another
waste collector,processor,or licensed land
disposalfacility.

*

A processorprocesses, repackages, or
otherwise treats low-level radioactivematerial
or waste generatedby others before the
eventual transferof the waste, or waste residue,
to a licensed landdisposalfacility.

2.

Manifest Number - Transfer the manifest number
from NRC Form 540, Item 8.

3.

Page 1 of _ Page(s) - Include the total number of
Form 542 and 542A pages.

4.

GeneratorIdentificationNumber - Each row should
include one of the generatorID numbersfrom NRC
Form 541, Item 5. All generatornumbers associated
23

NUREG/BR-0204, Rev. 2

receipt by the shipper identified in Item 5 of NRC
Form 540.

with generatorsto whom low-level radioactivewaste
is being attributedshould appear in this column.
5.

GeneratorName, PermitNumber (if applicable)
and Telephone Number - Specify the information
requestedabout the generatorto whom waste is being
attributed List one and only one generator,and
accompanyinginformation, in each block If the
permit number is reportedin Item 4, it need not be
repeatedhere. Provide the generatorinformation
requested in Items 6 through 11 in the same row.

6.

GeneratorFacilityAddress - List the complete
address of the generator'sfacility that has
contributed low-level waste to the shipment. List one
and only one generatoraddress in the block
consistent with the generatorinformation provided in
Item 5.

7.

PreprocessedWaste (or Material)Volume - Indicate
-the approximate volume in cubic meters (not
including the container)of the preprocessedwaste or
material. This is the volume of waste or material
receivedfrom the consignor'sfacility. This
information may be that indicatedon the consignor's
NRC Form 541, Item 12, or the shippingpaper used
to facilitate the transfer of radioactivematerial.

8.

Manifest Number(s) Under Which Waste (or
Material)Received and Date of Receipt - List the
previous manifest number(s) applicable to the lowlevel waste that has been attributedto the generator
listed in Item 5, and date(s) of waste or material

NUREGIBR-0204, Rev. 2

24

9.

Waste Code: Processedor Collected - Indicate the
properwaste code, "P"or "C,"using the definitions
of waste processorand waste collector in Appendix G
of 10 CFR Part 20. Do not mix processed and
collected waste on the same line, list separately.

10.

OriginatingCompact Region or State - Identify the
originatingcompact region, or unaffiliatedstate. The
information to be provided is for the original
generatorof the waste, as defined in Appendix G,
Section I, of 1O CFR Part20. For each generator
listed in Item 5, provide the information in the same
row. State abbreviationsmay be used Compact
abbreviationsmay be used when it cannot be
confused with a State abbreviation (do not use 2
letter Compact abbreviations).

11.

As Processed/CollectedTotal - For each original
generatorin Item 5, list the total Source Material(in
kilograms), Special Nuclear Material (in grams),
activity (in megabequerels)contained in the waste,
and the volume (in cubic meters) attributedto that
generator. Special Nuclear Material and Source
Material are defined in 10 CFR 70.4 and 40.4,
respectively.
Total of All Pages (NRC Form 542 and 542A) - At
the bottom of the page, indicate the totalsfor Items
I1A through I1D that are reportedon allpages of
the NRC Form 542 and 542A. Do not include
subtotals.

25

NUREG/BR-0204, Rev. 2

Use NRC Form 542A if additional
describe this shipment. Indicate space is needed to
the page number, total
number of Form 542 and 542A
pages, andthe manifest
number from NRC Form 540,
Item 8.

NUREG/BR-0204, Rev. 2

26

requirements of Federal and State Agencies for the same transportation and disposal of low-level waste.
Estimated burden per response to comply with this information collection request: 1.17 hours. This uniform manifest Is required by NRC to meet reporting 20i55-0001.
and to the Paperwork Reduction Project (3150-0164). Office of Management and Budget.
Forward comments regarding burden estimate to the Records Management Branch (T.6 F33), U.S. Nuclear Regulatory Commission. Washington, DC
Washington, DC 20503. If 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.
AIETNME

APPROVED BY OMB: NO. 3Ms"0%,4
EXPIRES: 05/31120o1

~~~~

NRC FORM 540
(5-1998)

--

-

U. S. NUCLEAR REGULATORY COMMISSION

-*pIS-

SHIPPER I.D. NUMBER

5. SHIPPER - NAME AND FACILITY

UNIFORM LOW-LEVEL RADIOACTIVE
WASTE MANIFEST
SHIPPING PAPER

USER PERMIT NUMBER

7. NRC FORM 540 AND 504A

PAGER%-"

PAGE I OF

NRC FORM 541 AND 541A

PAGE(S)

COLLECTOR

NRC FORM 542 AND 542A

PAGE(S)

PROCESSOR

ADDITIONAL INFORMATION

PAGE(S)

-~

--

---

-

GENERATOR TYPE
(Spearty)

SHIPMENT NUMBER

I

&

9. CONSIGNEE - Name and Facility Address

MANIFEST NUMBER

(Use this number on all continuation
pages)

CONTACT

1. EMERGENCY TELEPHONE NUMBER (Include Area Code)
(Include Area Code)

ORGANIZATION
6. CAHRIER
2. IS THIS AN 'EXCLUSIVE USE" SHIPMENT?

4. DOES EPA REGULATED
WASTE REQUIRING A
MANIFEST ACCOMPANY
THIS SHIPMENT?
If 'Yes," provide Manifest Number

YES

I

RC FORM 540 (5-1998)

-

__ -

- ____ - __

IELEP-'HUNIE NUMIIER

CONTACT

EPA MANIFEST NUMBER

(nclude Area Code)
t-

SIGNAITURE - Autrihzced camer acknowledging waste receipt

=>

r'~jN Fpr'F AflY
OR

EPA I.D.NUMBER

i __

NO
=

4

SHIPPING DATE

R

11. U.S. DEPARTMENT OF TRANSPORTATION DESCRIPTION
(Including proper shipping name, hazard class, UN ID number.
and any additional information)

'OR CONSIGNEE UsE ONLY

Name and Address

3. TOTAL NUMBER OF
PACKAGES IDENTIFIED
ON THIS MANIFEST

YES
NO

12.
DOT LABEL
"RADIOACTIVE'

13.
TRANSPORT
INDEX

TELEPHONE NUMBER (IncludeArea Code)

I LL-YH.UNE NUMBEX

CONTACT

14.
PHYSICAL AND
CHEMICAL FORM

DATE

'0

SIGNATURE - Authorizedconsignee acknowledging waste receipt

t

10. CERTIFICATION

I

DATE

&

This is to certify that the herein-named materials are property classified, described, packaged, marked, and labeled and are
in proper condition for transporataon according to the applicable regulations o 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
r'egulations.
K
DATE
TITLE
AUTHORIZED SIGNATURE

15.
INDIVIDUAL
RADIONUCUDES

___ _____ _____ _____ ____

1i.
TOTAL PACKAGE
ACTIVITY IN SI UNITS

17.
LSA/SCO
CLASS

18. TOTAL WEIGHT
OR VOLUME
(U3@appropriateunils)

19. IDENTIFICATION
NUMBER OF
PACKAGE

U.S. NUCLEAR REGULATORY COMMISSION 8. MANIFEST NUMBER

NRC FORM 540A

(Use this number on an continuaton pages)

UNIFORM LOW-LEVEL RADIOACTIVE

WASTE MANIFEST

PAGE

SHIPPING PAPER (CONTINUATION)
11. US. DEPARTMENT OF TRANSPORTATION DESCRIPTION
(Incauding proper shipping name, hazard classt UN IDnumber,
and any additonal informatio)

NRC ORM 54AC(395)-

12.
DOT LABEL
'RADIOACTIVE*

13.
TRANSPORT
INDEX

14.
PHYSICAL AND
CHEMICAL FORM

16.
TOTAL PACKAGE
ACTIVITY INSI UNITS

15.
INDIVIDUAL
RADIONUCLIDES

___

_____

17.
LSAJSCO
CLASS

OF_

18. TOTAL WEIGHT
OR VOLUME
(Use appropialeunits)

PAGE(S)
19. IDENTIFICATION
NUMBER OF
PACKAGE

APPROVED BY OMB: NO. 3150-0166
EXPIRES: 05/3112001

for the safe transportation and disposal of low-level
uniform manifest is required by NRC to meet reporing requirements of Federal and State Agencies
and
Estimated burden per response to comply with this information collection request: 5.43 hours. The U.S. Nuclear Regulatory Commission. Washington, DC20555-0
01, and to the Paperwork Reduction Project (3150-0166). Office of Management
Branch (r-6 F33),
Is not required to respond to. the information collection.
waste. Forward comments regarding burden estimate to the Records Management
valid OMB control number, the NRC may not conduct or sponsor, and a person
Budget, Washington. DC 20503. If an information collection does not display a currently
2. MANIFEST NUMBER
TOTALS
MANIFEST
W1.
"EW
NUCLEAR REGULATORY COMMISSION NUMER
SPECIAL NUCLEAR MATERIAL (grams)
NET WASTE
NET WASTE
PAKAES/
EIH
TOTAL
Pu
WEGTU23U-235
VOLUME
crPOSAL
3.
(kg)
(m 3)
AINERS

U.S.

NRC FORM 541
(5-1998)

15-IM)

~PACKAGESI

& PAGE -- I_ OF

UNIFORM LOW-LEVEL RADIOACTIVE

WASTE MANIFEST
TRImUM

ALL NUCLIDES
f Rdioativ Wate
Addiionl Ncler R~u~a~rYj~p~ 1________________I

CONTA INER A ND W ASTE DESCR IPTIO N

(NRC) Requirements for Control, Transfer and
Commission
Additional Nuclear Regulatory Disposal
of Radioactive Waste

CONTAINER
IDENTIFICATION
NUMBER
GENERATOR
ID NUMBER(S)

DESCRIP.
TION
N
(

F
SURFACE
RADIATION
LEVEL

9.

8.

7.

5.

VOLUME

WASTE
AND
N

VOUM
(m

WEIGHT
WEG)

(r~ir)

10.

SURFACE
COAMINATION
2
D
MB100 cmWASTE
BEC
BETA.
GAMMA

ALH

- --

NOTE 1: Container Description Codes. For containers/
waste requiring disposal In approved structural overpacks,
the numerical code must be followed by ".OP."
1. Wooden Box or Crate
2 Metal Box
4. PMtasl Drum or Pail
4. Metal Drum or Pail
5. Metal Tank or Liner
S.Concrete Tank or Liner
7. Polyethylene Tank or Liner

9. Demineralizer
10. Gas Cylinder
11. Bulk Unpackaged Waste
1Z. UnpackUad Components
13. High Integrity Container
19. Other. Describe In item 6.
or additional page

14.
(MBq)
C-14

Charcoal
Incinerator Ash
Sod
Gas
Oil
Aqueous Liquid
Filter Media
Mechanical Filter
EPA or State Hazardous

SHIPPER NAME

ISHIPPER
SOURCE

SHIPPERIDNUMBER

1(129

Tc-99

ID)NUMBER

PHYSICAL DESCRIPTION
.

12.

ORL
TOR
(See Note 2)

APPROMATE

13. SORBENT
SOLIDIFICATION.

APPROMEASTE
VOLUME(S) IN
CONTAINER

STABILIZATION.
MEDIA
(See Note 3)

WEIGHT
%

38.
39.
40.
41.
42.
43.
59.

CHELATING
AGENT
IF > 0.1%

CHEMICAL FORM/

Evaporator Bottoms/Sludges/Concentrates
CompactibleTrash
Noncompactible Trash
Animal Carcass
Biological Material (except animal carcass)
Activated Material
Other. Describe in item 11,
or additional page

_

INDIVIDUAL RADIONUCIUDES AND ACTIVITY (MB.) AND

CLASSIFICATION
AS-Class A
Stable

CONTAINER TOTAL; OR CONTAINER TOTAL ACTIVITY
AND RADIONUCLIDE PERCENT

AU-Class A
UtClassB
C
C.-Class
B-Class B

RADIOLOGICAL DESCRIPTION

15.

CHEMICAL DESCRIPTION

14.'

_

-- -

29. Demolition Rubble
30. Cation Ion-exchange Media
31. Anion Ion-exchange Media
S32. Mited Bed Ion-exchange Media
33. Contaminated Equipment
34. Organic Liquid (except oil)
35. Glassware or Labware
38. Sealed Source/Device
37. Paint or Plating

16.

WASTE DESCRIPTION FOR EACH WASTE TYPE IN CONTAINER

_________

Note 2: Waste Descriptor Codes. (Choose up to three which predominate by volume.)

20.
21.
22.
23.
24.
25.
26.
27.
28.

PAGE(S)

I___________WASTE

_________
DISPOSAL CONTAINER DESCRIPTION

II

ACTIVITY

__

_

the numerical code must be followed by "-S.
Note 3: For solidification media that meet disposal site structural stability requirements,
be Identified In Item 13. Code 100-NONE REQUIRED.
For all solidlflcation media, the vendor (manufacturer) and brand name must also

Solidification

Sorption
60. Speedi Dii
61. Celetom

62. Floor Dry/
Superine
63. Hi Dri

64.
65.
66.
67.
68.

Safe T Sorb
Sale N Dn
Florco
Florco X
Solid A Sorb

69.
70.
71.
72.
73.

Chearnsil 30
Chernsil 50
Chemsil 3030
Dicaped HP200
Dicaped HPSO0

74.
75.
76.
77.

Petroset
Petroset It
Aquaset
Aquaset II

89. Other.
Describe in
item 13, or
additional
page

94. Vinyl Ester Styrene
90. Cement
99. Other. Describe
91. Concrete
in item 13, or
(encapsulation)
additional page
92. Bitumen
93. Vinyl Chloride 100. None Required

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 541A

UNIFORM LOW-LEVEL RADIOACTIVE
WASTE MANIFEST

.

CONTAINER AND WASTE DESCRIPTION (CONTINUATION)

CONTAINER DESCRIPTION
DISPOSAL
,__•_WASTE
5.
CONTAINER
IDENTIFICATION

(3 )

GB',IERATOR
GEN

IDNMER(S)

8.

7.
6.
CONTAINER
DESCRIP.
(SeeNOte 1)

(in)

9.

2- MANIFESTNUMBER

PAGE

-

OF

10.

SURFACE
WASTE
RADIATION•
AND
ER
CONTVLN
EGTDESCRIP.
l
EVR
COTI
VA4BETAWEIGHT

14.

PHYSICAL DESCRIPTION

SURFACE
CONTAMINATION
C1.

12.

13. SORBENT

10

MEDIA
(See Note 3)

(mSvrh)

=

GET

MEDIAN

~.

L

RADIOLOGICAL DESCRIPTION

WEIGHT

INDIVIDUAL RADIONUCLIDES AND ACTIVITY (M0Bq)AND
CONTAINER TOTAL; OR CONTAINER TOTAL ACTIVITY

AGENT
IF 3 0.1%

AND RADIONUCLIDE PERCENT

SOLIDIFICATION.
CHEMICANG AETO
wASTE
SAIZTONCHMALFR/CHELATING
WASPOXMTE STABILIZATION,

WSTEI
VOLUME(S)INW
TOR
"[OR ft)MALPHA

MD/10m

15.

PAGE(S)
1i.

WASTE DESCRIPTION FOR EACH WASTE TYPE IN CONTAINER
CHEMICAL DESCRIPTION

_

CLASSIFICATION
AS-Class A
Stable
Ab
UnClst
CasA
ntal

B
a
C .,lass C

APPROVED BY OMB: NO. 3150-0165
EXPIRES: 513112001
NRC FORM 642

of low-level
Estimated burden per resonse to comply with this Information collection request: 26 minutes. The uniform manifest Is required by NRC to meet report requirements of Federal and State Agencies for the safe transportation and disposal
Office of Management and
Nuclear Regulatory Commission. Washington. DC 2055540001, and to the Paperwork ReductionIt Project (3150-0165).
waste. Forward comments regarding burden estimate to the Records Management Branch (T-6 F33), U.S.nututmni
It-..'.,f.
tuuu
uimituinUt
tbUU
andoa~i
-uruu
P.~".
ua ..

~

~

Iii-, U0bI,
uo
100
1
1-,rrm~,
#.t IAI.,
.a..yu.L:
0.ay.
A
ooe• .us .=iay.
1 an nfurmation co..,
t'
ng,=on,,,,= •uoa.
uu g, ,Ia
U.S. NUCLEAR REGULATORY COMMISSION 1.

~uon

cano

o,
conlronumer mr, ,q•,.. may nu c..u,......
curremni•vai~o ,.WMD
WASTE COLLECTORPROCESSOR

perso

o.,.
au..n. umau, ,.,on
2 MANIFEST NUMBER

-uiredo rvespond o,
s n.. req.,
•.'-

(5.1998)

UNIFORM LOW-LEVEL RADIOACTIVE

SHIPPER USE ONLY

NAME

WASTE MANIFEST

IDENTIFICATION NUMBER
3.

MANIFEST INDEX AND REGIONAL COMPACT TABULATION

4.

List all original "PROCESSED WASTE" generators (if any)
before "COLLECTEDWASTE" generators.
6.
5.
GENERATOR

GENERATGENERATOR

IDENTIFICATION
NUMBER

PERMIT NUMBER OFAPPLICABLE),
AND TELEPHONE NUMBER

PAGE

SHIPPING DATE

I

PAGE(S)

OF

1

__
ENERATOR
FACILITY
ADDRESS

8.
7.
PREPROCESSEDO______
MANIFEST NUMBER(S) UNDER
WASTE
(OR MATERIAL)
VOLUME
3

WHICH WASTE (OR MATERIAL)
RECEIVED AND DATE
OF RECEIPT

(rn3

10.

9.

AS PROCESSEDICOLLECTED TOTAL

11.

WASTE CODE

ORIGINATING

P . PROCESSED
Cc COLLECTED

COMPACT
S
REGION
OR STATE)

TOTALS OF ALL PAGES (NRC FORMS 542 AND 542A)

A. SOURCE
C. ACIVITY
(kg

(9

(I~~q)(i3n)

D. VOLUME