NRC Form 542A Uniform Low-Level Radioactive Waste Manifest Index and R

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 FOIA, Privacy, and Information Collections Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by 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 imp ose 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. 3150-0165
EXPIRES: (MM/DD/YYYY)

NRC FORM 542A

U.S. NUCLEAR REGULATORY COMMISSION

(MM-YYYY)

2. MANIFEST NUMBER

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST
MANIFEST INDEX AND REGIONAL COMPACT TABULATION (Continuation)

3.

PAGE

Instructions: See NUREG/BR-0204 for detailed instructions for completing this form: http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/
4.

6.

5.
GENERATOR
IDENTIFICATION
NUMBER

NRC FORM 542A (MM-YYYY)

GENERATOR NAME
PERMIT NUMBER (IF APPLICABLE)
AND TELEPHONE NUMBER

7.
GENERATOR
FACILITY
ADDRESS

PREPROCESSED
WASTE (OR MATERIAL)
VOLUME (m3 )

8.

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

11.

OF

PAGE(S)

AS PROCESSED/COLLECTED TOTAL
A. SOURCE
MATERIAL
(kg)

B. SNM
(g)

C. ACTIVITY
(MBq)

D. VOLUME
(m3 )