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

APPROVED BY OMB: NO. 3150-0165 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 [email protected], and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0166), Office of Management
EXPIRES: (MM/DD/YYYY)
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.

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 542

(MM-YYYY)

WASTE COLLECTOR/PROCESSOR

1.

2. MANIFEST NUMBER

SHIPPER USE ONLY

NAME

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST
MANIFEST INDEX AND REGIONAL COMPACT TABULATION
IDENTIFICATION NUMBER

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

3.
SHIPPING DATE

PAGE

List all original "PROCESSED WASTE" generators (if any)
before "COLLECTED WASTE" generators.
4.

GENERATOR
IDENTIFICATION
NUMBER

5.

GENERATOR NAME
PERMIT NUMBER (IF APPLICABLE)
AND TELEPHONE NUMBER

6.

GENERATOR
FACILITY
ADDRESS

7.
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

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

11.

OF

PAGE(S)

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

B. SNM
(g)

C. ACTIVITY
(MBq)

D. VOLUME
(m3 )