541 Uniform Low-Level Radioactive Waste Manifest Container a

Estimated burden per response to comply with this information collection request: 3.3 hours. 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 FOIA, Privacy and Information Collections Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to [email protected], and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202,
(3150-0166), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information 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. 3150-0166
EXPIRES: (MM/DD/YYYY)

U. S. NUCLEAR REGULATORY COMMISSION

NRC FORM 541
(MM-YYYY)

UNIFORM LOW-LEVEL RADIOACTIVE
WASTE MANIFEST

1. MANIFEST TOTALS
NUMBER OF
PACKAGES/
DISPOSAL
CONTAINERS

NET WASTE
VOLUME
3
(m )

NET WASTE
WEIGHT
(kg)

CONTAINER
IDENTIFICATION
NUMBER/
GENERATOR
ID NUMBER(S)

7.

CONTAINER
DESCRIPTION
(See Note 1)

VOLUME
(m3 )

8.
WASTE
AND
CONTAINER
WEIGHT
(kg)

9.

SURFACE 10.
RADIATION
LEVEL

(µSv/hr)
(mSv/hr)

U-235

TOTAL

Pu

ACTIVITY (MBq)
ALL NUCLIDES

C-14

TRITIUM

DISPOSAL CONTAINER DESCRIPTION
6.

5.

U-233

3.

PAGE

OF

SOURCE
(kg)

I-129

Tc-99

SHIPPER I.D. NUMBER

WASTE DESCRIPTION FOR EACH WASTE TYPE IN CONTAINER
SURFACE
CONTAMINATION
MBq/100cm 2
BETAGAMMA

ALPHA

PAGE(S)

4. SHIPPER NAME

CONTAINER AND WASTE DESCRIPTION

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

2. MANIFEST NUMBER

SPECIAL NUCLEAR MATERIAL (grams)

PHYSICAL DESCRIPTION
11.
WASTE
DESCRIPTOR
(See
Note 2)

12.

13.

APPROXIMATE
WASTE
VOLUME(S) IN
CONTAINER

SORBENT
SOLIDIFICATION,
STABILIZATION,
MEDIA
(See Note 3)

RADIOLOGICAL DESCRIPTION

CHEMICAL DESCRIPTION
14.
CHEMICAL FORM/
CHELATING AGENT

WEIGHT
%
CHELATING
AGENT
IF > 0.1%

15.
INDIVIDUAL RADIONUCLIDES AND ACTIVITY (MBq) AND
CONTAINER TOTAL; OR CONTAINER TOTAL ACTIVITY
AND RADIONUCLIDE PERCENT

16. WASTE
CLASSIFICATION
AS-Class A
Stable
AU-Class A
Unstable
B-Class B
C-Class C

17.
MEETS
WAC
REQUIREMENTS?
YES
or
NO

YES
NO
YES
NO

YES
NO
YES
NO
YES
NO

YES
NO

NOTE 1: Container Description Codes. For containers/
waste requiring disposal in approved structural overpacks,
the numerical code must be followed by "-OP."
1.
2.
3.
4.
5.
6.
7.
8.

Wooden Box or Crate
Metal Box
Plastic Drum or Pail
Metal Drum or Pail
Metal Tank or Liner
Concrete Tank or Liner
Polyethylene Tank or Liner
Fiberglass Tank or Liner

9.
10.
11.
12.
13.
14.

NRC FORM 541 (MM-YYYY)

Demineralizer
Gas Cylinder
Bulk Unpackaged Waste
Unpackaged Components
High Integrity Container
Other. Describe in item 6,
or additional page

NOTE 2: Waste Descriptor Codes. (Choose up to three which predominate by volume.)
20.
21.
22.
23.
24.
25.
26.
27.
28.

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

29.
30.
31.
32.
33.
34.
35.
36.
37.

Demolition Rubble
Cation Ion-exchange Media
Anion Ion-exchange Media
Mixed Bed Ion-exchange Media
Contaminated Equipment
Organic Liquid (except oil)
Glassware or Labware
Sealed Source/Device
Paint or Plating

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

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

NOTE 3: For solidification media that meet disposal site structural stability requirements, the numerical code must be followed by "-S."
For all solidification media, the vendor (manufacturer) and brand name must also be identified in item 13. Code 100=NONE REQUIRED.

Solidification

Sorption
60. Speedi Dri
61. Celetom
62. Floor Dry/
Superfine
63. Hi Dri

64.
65.
66.
67.
68.

Safe T Sorb
Safe N Dri
Florco
Florco X
Solid A Sorb

69.
70.
71.
72.
73.

Chemsil 30
Chemsil 50
Chemsil 3030
Dicaperl HP200
Dicaperl HP500

74.
75.
76.
77.

Petroset
Petroset II
Aquaset
Aquaset II

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

94.
90. Cement
99.
91. Concrete
(encapsulation)
92. Bitumen
100.
93. Vinyl Chloride

Vinyl Ester Styrene
Other. Describe
in item 13, or
additional page
None Required