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

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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

20555-

0001

OR

TELEPHONE

301-415-5877

OR

E-MAIL

ADDRESS

<INTERNET:BAM1

@NRC.GOV>.

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:

(1)

NRC

Form

540

and

540A':

Uniform Low-

Level

Radioactive

Waste

Manifest

(Shipping

Paper)

and

continuation

page;

(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.

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

Compact

manifesting requirements

may

encompass

shipments beyond

those

defined

by the

NRC.

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.

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.

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

with

Department

of

Transportation

(DOT)

regulations.

NUREG/BR-0204,

Rev.

2

4

NRC

FORM

540:

UNIFORM

LOW-LEVEL

RADIOACTIVE

WASTE

MANIFEST

(Shipping

Paper)

NRC

Form

540

must

be

completed

for

shipments

of

low-

level

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

organization

responsible

for

providing

the

emergency

response information.

Note

that

additional

emergency response

information

must

be

available

and

presented

in

accordance

with

49

CFR

172.602.

2.

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-0204,

Rev.

2

3.

Total

Number

of

Packages

Identified

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

shipper should

also

identify

the

EPA

manifest number

in

the

space

provided

(if

acceptable

to

the

consignee,

the

manifest

number

appearing

in

Item

8

of

NRC

Form

540

may

be

identical

to

the

EPA

manifest

number).

5.

Shipper

-

Indicate

the

comnpany

or

facility

name,

facility

address,

contact

person,

and

telephone

number.

If

applicable,

indicate

the

permit

or

other

similar

number

assigned

to

the

shipper

by

the

appropriate

host

State

in

which

the

designated

licensed

disposal

facility

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

shipper

identification

number

is

provided

for

the

shipper

to

record

the

number,

if

any,

assigned

to

the

shipper

by

the

consignee

or

the

designated

disposal

facility

operator.

A

space

provided

under

the

heading,

"SHIPMENT

NUMBER,

"isfor

any

use

deemed

appropriate

by

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

authorized

carrier

representative

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

additional

information

(e.g.,

host

State)

that

requires

a

separate

page

or

pages

and

is

a

part

of

this manifest.

If

an

EPA

manifest

accompanies

the

NRC

Forms,

do

not

include

its

pages

in

Item

7.

If

NRC

Form

542

or

additional

pages

are

not

part

of

this

manifest,

enter

"None"

in

the

appropriate

blank.

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

additional

information.

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.

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.

10.

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.

11.

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.

12.

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

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

authorized

carrier

representative

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

additional

information

(e.g.,

host

State)

that

requires

a

separate

page

or

pages

and

is

a

part

of

this

manifest.

If

an

EPA

manifest

accompanies

the

NRC

Forms,

do

not

include

its

pages

in

Item

7.

If

NRC

Form

542

or

additional

pages

are

not

part

of

this

manifest,

enter

"None"

in

the

appropriate

blank.

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

additional

information.

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.

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.

10.

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.

11.

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.

12.

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.

Identification

Number

of

Package

-

For

each

package,

a

package

identification

number,

unique

among

the

individual

package

identification

numbers

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

IN

THIS

SPACE

IS

TO

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

low-

level

waste

disposal containers

described

on

this

manifest (the

total

number

ofpackages

may

be

listed,

if

the

consignee

is

not

a

licensed

low-level

waste

disposal

facility),

the

total

net waste

volume

(cubic

meters),

and

the total net

weight (kilograms).

Appendix

G

of

10

CFR Part

20

requires separate

11

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

disposal

containers

containing

NUREG/BR-0204,

Rev.

2

12

each

type

of

Special

Nuclear

Material

in

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

media)

is

requested.

No

more

than

one

generator

should

be

listed

per

outlined

row.

Individual

consignees

(e.g.,

disposal

facility

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

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.,

disposal

facility

operators)

may

require

a

greater

sensitivity

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

require

specific

sensitivities

of

measurement.

9.

Surface

Radiation

Level (jtSv/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

(MBq/1J00

cm

2

):

Alpha,

Beta-Gamma

-

Record

the

results

of

contamination

surveys

performed

on

the

disposal

container.

Do

not

use

"BKG

"for

background

levels

unless

the

background

level

is

indicated

in

this

column.

Estimated

values

are

acceptable

ifpotential

occupational

exposures

limit

survey

data

collection.

15

NUREG/BR-0204,

Rev.

2

11.

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.,

disposal

facility

operators)

may

require

more

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.

12.

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

radiological

descriptions.

Similarly,

individual

disposal

facilities

may

require

solidification

of

certain

wastes

(e.g.,

oil)

in

specified

media

and

may

require

identification

of

media

vendor

(manufacturer)

and

brand

name.

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

NUREG/BR-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

of

radiological

descriptions

or

may

not

allow

the

alternative

method

of

reporting

described

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

separating

rows

are

not intended

to

limit

the

vertical

NUREG/BR-0204,

Rev.

2

20

reporting

of

nuclides

and

activities,

but

are

provided

to

aid

the

transcription

and

readability

of

the

provided

information.

16.

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

541A

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.

21

NUREG/BR-0204,

Rev.

2

I

NRC

FORM

542:

UNIFORM

LOW-LEVEL RADIOACTIVE

WASTE

MANIFEST

(Manifest

Index

and

Regional

Compact

Tabulation)

1.

Waste

Collector/Processor

- Complete

the

collector

or processor's'name,

ID

number,

and

the

shipping

date.

Space

has'

also

been

provided

for

any

use

deemed

appropriate

by

the

shipper.

A

waste

collector

or

processor

is

an

entity,

operating

under

a

Commission

or

Agreement State

license,

whose

principal

purpose

for

possessing

the

radioactive

material or

waste

is

asfollows:

*

A

collector

collects

and

consolidates

waste

generated

by

others

and

transfers

this

waste,

without

processing

or.

repackaging,

to

another

waste

collector,

processor,

or

licensed land

disposal

facility.

*

A

processor

processes,

repackages,

or

otherwise

treats

low-level

radioactive

material

or

waste

generated

by

others

before

the

eventual

transfer

of

the

waste,

or

waste

residue,

to

a

licensed

land

disposal

facility.

2.

Manifest

Number

-

Transfer

the

manifest

number

from

NRC

Form

540,

Item

8.

3.

Page

I

of__

Page(s)

-

Include

the

total

number

of

Form

542

and

542A

pages.

4.

Generator

Identification

Number

-

Each

row

should

include

one

of

the

generator

ID

numbers

from

NRC

Form

541,

Item

5.

All

generator

numbers

associated

23

NUREG/BR-0204,

Rev.

2

with

generators

to

whom

low-level

radioactive

waste

is

being

attributed

should

appear

in

this

column.

5.

Generator

Name,

Permit

Number

(if

applicable)......

and

Telephone

Number

-

Specify

the

information

requested about

the

generator

to

whom

waste

is

being

attributed

List

one

and

only

one

generator,

and

accompanying

information,

in

each

block.

If

the

permit

number

is

reported

in

Item

4,

it

need

not

be

repeated

here.

Provide

the

generator

information

requested

in

Items

6

through

11

in

the

same

row.

6.

Generator

Facility

Address

-

List

the

complete

address

of

the

generator's

facility

that

has

contributed

low-level waste

to

the

shipment.

List

one

and

only

one

generator

address

in

the

block

consistent

with

the

generator

information

provided

in

Item

5.

7.

Preprocessed

Waste

(or

Material)

Volume -

Indicate

the

approximate

volume in

cubic meters

(not

including

the

container)

of

the

preprocessed

waste

or

material.

This

is

the

volume

of

waste

or

material

received

from

the

consignor's

facility.

This

information

may

be

that

indicated

on

the

consignor's

NRC

Form

541,

Item

12,

or

the

shipping

paper

used

to

facilitate

the

transfer

of

radioactive

material.

8.

Manifest

Number(s)

Under

Which

Waste

(or

Material)

Received

and

Date

of

Receipt

-

List

the

previous

manifest

number(s)

applicable

to

the

low-

level

waste

that

has

been

attributed

to

the

generator

listed

in Item

5,

and

date(s)

of

waste

or material

NUREG/BR-0204,

Rev.

2

24

receipt

by

the

shipper

identified

in

Item

5

of

NRC

Form

540.

9.

Waste

Code:

Processed

or

Collected

-

Indicate

the

proper

waste code,

"P"

or

"C,

"

using

the

definitions

of

waste

processor

and

waste

collector

in

Appendix

G

of

10

CFR

Part

20.

Do not

mix

processed

and

collected

waste

on

the

same line,

list separately.

10.

Originating

Compact

Region

or

State

-

Identify

the

originating

compact

region,

or

unaffiliated

state.

The

information

to be

provided

is

for

the

original

generator

of

the

waste,

as

defined

in

Appendix

G,

Section

I,

of

1O

CFR

Part

20.

For

each

generator

listed

in

Item

5,

provide

the

information

in the

same

row. State

abbreviations

may

be

used

Compact

abbreviations

may

be

used

when

it

cannot

be

confused

with

a

State

abbreviation

(do

not

use

2

letter

Compact

abbreviations).

11.

As

Processed/Collected

Total

-

For

each

original

generator

in 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)

attributed

to

that

generator.

Special

Nuclear

Material

and

Source

Material are

defined

in

10

CFR

70.4

and

40.4,

respectively.

Total

ofAll

Pages

(NRC

Form

542

and

542A)

-

At

the

bottom

of

the

page,

indicate

the

totals

for

Items

I

IA

through

lID

that

are

reported

on

all pages

of

the

NRC

Form

542

and

542A.

Do

not

include

subtotals.

25

NUREG/BR-0204,

Rev.

2

Use

NRC

Form

542A

if

additional

space

is

needed

to

describe

this

shipment.

Indicate

the

page

number,

total

number

of

Form

542

and

542A

pages,

and

the

manifest

number

from

NRC

Form

540,

Item

8.

NUREG/BR-0204,

Rev.

2

26

APPROVED

BY OMB:

NO.

3150-0164

Estimated

burden

per

response

to

comply

with

this

information

collection

request:

1.17

hours.

This

uniform

manifest

is

required

by

NRC

to

meet

reporting

requirements

of

Federal

and

State

Agencies

for

the

same

transportation and

disposal

of

low-level

waste.

EXPIRES:

05131l2001

Forward

comments

regarding

burden

estimate

to

the

Records

Management

Branch

(T-6

F33),

U.S.

Nuclear

Regulatory

Commission,

Washington,

DC

20555-0001,

and

to

the

Paperwork

Reduction

Project

(3150-0164),

Office

of

Management

and

Budget,

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.

NRC

FORM

540

(5-1998)

U.

S.

NUCLEAR

REGULATORY

COMMISSION

15.

SHIPPER

-

NAME

AND

FACILITY

UNIFORM

LOW-LEVEL

RADIOACTIVE

WASTE

MANIFEST

SHIPPING

PAPER

SHIPPER

ID.

NUMBER

COLLECTOR

PROCESSOR

GENERATORTYPE

(Specify)

7.

NRC

FORM

540

AND

504A

NRC

FORM 541

AND

541A

NRC

FORM

542

AND

542A

ADDmONAL

INFORMATION

PAGE

1

OF

__

PAGE(S)

___

PAGE(S)

___

PAGE(S)

PAGE(S)

8.

MANIFEST NUMBER

(Use

this

number

on

all

continuation

pages)

I

a

I

USER

PERMIT NUMBER

1.

EMERGENCY TELEPHONE

NUMBER

(Include

Area Code)

ORGANIZATION

SHIPMENT

NUMBER

9.

CONSIGNEE

--

Name

and

Facility

Address

CONTACT

CONTACT

TELEPHONE

NUMBER

(Include

Area

Code)

TELEPHONE

NUMBER

(Include Area

Code)

&

i

.1.

6.

CARRIER

-

Name and

Address

EPA

I.D.

NUMBER

SIGNATURE

-

Aufhcrized

consignee

acknowledging

waste

receipt

DATE

2.

IS

THIS

AN

"EXCLUSIVE

USE'

SHIPMENT?

YES

NO

3.

TOTAL

NUMBER

OF

PACKAGES

IDENTIFIED

ON THIS

MANIFEST

'6

SHIPPING

DATE

10.

CERTIFICATION

I

9

I

I

DOES

EPA

REGULATED

II

YES

WASTE

REQUIRING

A

NO

MANIFEST

ACCOMPANY

N

THIS

SHIPMENT?

If

"Yes,"

provide

Manifest

Number

EPA

MANIFEST NUMBER

CONTACT

TILEPHOUNE

NUMBIER

(Include Area

Code)

This is

to

certify

that

the herein-named materials

are

properly

classified,

described, packaged,

marked,

and

labeled and

are

in

proper

condition

for

transportation according

to the

applicable

regulations

of

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

reoulations.

1

_________

SIGNATURE

-

Authorized

carrier

acknowledging

waste

receipt

DATE

AUTHORIZED SIGNATURE

TITLE

DATE

11.

U.S.

DEPARTMENT

OF

TRANSPORTATION

DESCRIPTION

12.

13.

14.

15.

16.

17.

18.

TOTAL

WEIGHT

19.

IDENTIFICATION

Oncluding

proper

shipping

name,

hazard

class,

UN

ID

number,

DOT

LABEL

TRANSPORT

PHYSICAL

AND

INDIVIDUAL

TOTAL

PACKAGE

LSA/SCO

OR

VOLUME

NUMBER

OF

and

any

additional

information)

"RADIOACTIVE"

INDEX

CHEMICAL

FORM

RADIONUCLIDES

ACTIVITY

IN

SI

UNITS

CLASS

(Use

appropriate

units)

PACKAGE

r

4

1

4

1

I

*

+

I'

4

4

4

1

r

r

1

4

1

4

*

+

I

4

-

4

4

1

4

r

r

4

1

4

1

4

I

I

I

i

I

I

C

NI'IR,

FURM

54U

(5-1998)

NRC FORM

540A

U.S.

NUCLEAR

REGULATORY

COMMISSION

8.

MANIFEST NUMBER

(3-W

(Use

this number

on

all

continuation

pages)

UNIFORM

LOW-LEVEL

RADIOACTIVE

WASTE

MANIFEST

SHIPPING

PAPER

(CONTINUATION)

PAGE

OF

PAGE(S)

11.

U.S.

DEPARTMENT

OF

TRANSPORTATION

DESCRIPTION

12.

13.

14.

15.

16.

17.

18.

TOTAL

WEIGHT

19.

IDENTIFICATION

(Including

proper

shipping

name,

hazard

class,

UN

ID

number,

DOT

LABEL

TRANSPORT

PHYSICAL

AND

INDIVIDUAL

TOTAL

PACKAGE

LSA/SCO

OR

VOLUME

NUMBER OF

and any

additional

information)

"RADIOACTIVE'

INDEX

CHEMICAL FORM

RADIONUCLIDES

ACTIVITY

IN

SI

UNITS

CLASS

(Use

appropriate

units)

PACKAGE

NRC

FORM

540A

(3-95)

APPROVED

BY

OMB:

NO.

3150-0166

Estimated

burden

per

response

to

comply

with

this

information

collection

request:

5.43

hours.

The

uniform

manifest

is

required

by

NRC

to meet

reporting

requirements

of

Federal

and

State

Agencies

for

the

safe

transportation

and

disposal

of

low-level

EXPIRES:

05131/2001

waste.

Forward

comments

regarding

burden

estimate

to

the

Records

Management

Branch

(T-6

F33),

U.S.

Nuclear

Regulatory

Commission,

Washington,

DC

20555-0001,

and

to

the

Paperwork

Reduction

Project

(3150-0166),

Office

of

Management

and

Budget.

Washinaton.

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.

NRC

FORM

641

U.S.

NUCLEAR

REGULATORY

COMMISSION

1.

MANIFEST

TOTALS

2.

MANIFEST

NUMBER

(5-1998)

NUMBER

OF

NET

WASTE

NET

WASTE

SPECIAL

NUCLEAR

MATERIAL

(grams)

DISPOSAL

VOLUME

WEIGHT

CONTAINERS

(m

3)

(kg)

U-233_U-235

TOTAL

UNIFORM

LOW-LEVEL

RADIOACTIVE

3

PAGE

1

OF

__

PAGE(S)

WASTE

MANIFEST

4.

SHIPPER

NAME

ACTIVITY

(MBq)

SOURCE

CONTAINER

AND

WASTE

DESCRIPTION

ALL

NUCLIDES

TRmUM

C-14

Tc-99

1-129

(kg)

SHIPPER

ID

NUMBER

Additional

Nuclear

Regulatory

Commission

(NRC)

Requirements

for

Control,

Transfer

and

Disposal

of Radioactive

Waste

___

DISPOSAL

CONTAINER

DESCRIPTION

WASTE

DESCRIPTION

FOR

EACH

WASTE

TYPE

IN

CONTAINER

16.

WASTE

5.

6.

7.

8.

9.

10.

SURFACE

PHYSICAL

DESCRIPTION

14.'

CHEMICAL

DESCRIPTION

15.

RADIOLOGICAL

DESCRIPTION

CLASSIFI-

CONTAINER

CONTAINER

WASTE

SURFACE

CONTAMINASON

-CATION

AD

RADIATION

COTMNTO

I1.

12.

13.

SORBENT

WIH

,-ls

IDENTIFICATION

DESCRIP-

VOUE

AND

RDAIN2A-ls

NUMBER)

TION

VOLUME

LEVEL

MBq/100

cm

WASTE

APPROXIMATE

SOLIDIFICATION,

%

INDIVIDUAL

RADIONUCLIDES

AND

ACTIVITY

(MBq)

AND

Stable

IDENE

CONTAINER

DESCRIP-

WASTE

STABILIZATION,FORM/

U-Class

A

GENERATOR

(m3)

WEIGHT

CHELATING

CONTAINER

TOTAL;

OR

CONTAINER

TOTAL

ACTIVITY

(e

Note

1)

m(.uiSv/hr)

ALPHA

BETA-

TOR

VOLUME(S)

IN

MEDIA

CHELATING

AGENT

AGENT

AND

RADIONUCLIDE

PERCENT

-Classtb

IDSee

Note

1)

NUMB

GAMMA

See

Note

2)

CONTAINER

(SeNoe3

(SeeNote3)

IF

0.1%

C-Class

C

flit

£.

0SWUVL

*p~fl

J5.~~,iS

p

U

U11

W110

p

Ctlhi~iiiL

M

VI*UISC.

waste

requiring

disposal

In

approved structural

overpacks,

the

numerical

code must

be

followed

by

"-OP."

1.

Wooden

Box

or

Crate

9.

Demineralizer

2.

Metal

Box

10.

Gas

Cylinder

3.

Plastic

Drum

or

Pail

11.

Bulk,

Unpackaged

Waste

4.

Metal

Drum

or Pail

12.

Unpackaged

Components

5.

Metal

Tank or

Liner

13.

High Integrity

Container

S.

Concrete

Tank

or

Liner

19.

Other.

Describe

in

item

6,

7.

Polyethylene

Tank

or

Liner

or

additional page

B.

Fiberalass

Tank

or

Liner

-

Z:

-

C

F-r

-

es.

%-oose

up

-

three

-

c

pre

om

mite

by

vo

ume.,

For

all

solidification

media,

the

vendor

(manufacturer)

and

brand

name

must

also

be

Identified

In

Item 13.

Code

100-NONE

REQUIRED.

20.

Charcoal

21.

Incinerator

Ash

22.

Soil

23. Gas

24.

Oil

25.

Aqueous

Liquid

26.

Filter

Media

27.

Mechanical

Filter

28.

EPA

or

State

Hazardous

29.

Demolition Rubble

30.

Cation Ion-exchange

Media

31.

Anion

Ion-exchange

Media

32.

Mixed

Bed Ion-exchange

Media

33.

Contaminated

Equipment

34.

Organic

Liquid

(except

oil)

35.

Glassware

or

Labware

36.

Sealed

Source/Device

37.

Paint

or

Plating

38. Evaporator

Bottoms/Sludges/Concentrates

39. CompactibleTrash

40. Noncompactible

Trash

41.

Animal

Carcass

42.

Biological

Material

(except

animal

carcass)

43.

Activated Material

59. Other.

Describe

in

item

11,

or

additional

page

Sorption

60. Speedi

Dri

61.

Celetom

62.

Floor

Dry/

Superfine

63.

Hi

Dri

64.

Safe

T

Sorb

65.

Safe

N

Dri

66.

Florco

67.

Florco

X

68.

Solid

A

Sorb

69.

Chemsil

30

70.

Chemsil

50

71.

Chemsil

3030

72.

Dicaperl

HP200

73.

Dicaped

HP500

74.

Petroset

75.

Petroset

II

76. Aquaset

77.

Aquaset

11

89.

Other.

Describe

in

item 13, or

additional

page

Solidification

90.

Cement

94.

Vinyl

Ester

Styrene

91.

Concrete

99.

Other.

Describe

(encapsulation)

in

item

13, or

92.

Bitumen

additional page

93.

Vinyl

Chloride

100. None

Required

NRC

FORM

541

(5-1998)

U

NRC

FORM

"41A

(3-

UNIFORM

LOW-LEVEL

RADIOACTIVE

WASTE

MANIFEST

CONTAINER

AND

WASTE

DESCRIPTION

(CONTINUATION)

U.S.

NUCLEAR

REGULATORY

COMMISSION

12.

MANIFEST

NUMBER

3.

PAGE

__

OF

__

PAGE(S)

a

.

-

WASTE

DESCRIPTION

FOR

EACH

WASTE

TYPE

IN

CONTAINER

14.

CHEMICAL

DESCRIPTION

15.

RADIOLOGICAL

DESCRIPTION

t

CHEMICAL

FORM/

CHELATING

AGENT

WEIGHT

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AGENT

IF

>

0.1%

INDIVIDUAL

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AND

ACTIVITY

(MBq)

AND

CONTAINER

TOTAL;

OR

CONTAINER

TOTAL

ACTIVITY

AND

RADIONUCLIDE

PERCENT

16.

WASTE

CLASSIFI-

CATION

AS-Class

A

Stable

AU-Class

A

Unstable

B-Class

B

C-Class

C

4

4.

4

4

*

4

-

4

4.

4

4

*

4

4

*

4

4.

4.

4

4.

4

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*

4

4-

4

4

NRC

FORM

641A

U.S.

NUCLEAR REGULATORY

COMMISSION

2.

MANIFEST NUMBER

UNIFORM

LOW-LEVEL

RADIOACTIVE

WASTE

MANIFEST

CONTAINER

AND

WASTE

DESCRIPTION

(CONTINUATION)

PAGE

OF

__

PAGE(S)

DISPOSAL

CONTAINER

DESCRIPTION

WASTE DESCRIPTION

FOR

EACH

WASTE

TYPE

IN

CONTAINER

16.

WASTE

5.

6.

7.

8.

9.

10.

SURFACE

PHYSICAL

DESCRIPTION

14.

CHEMICAL

DESCRIPTION

15.

RADIOLOGICAL

DESCRIPTION

CLASSIFI-

CONTAINER

ONTAINER

WASTE

SURFACE

CONTAMINATION

CATION

IDENTIFICATION

DESCRIP-

AND

RADIATION

N11

12.

13.

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NUMBERN

TION

VOLU

CONTAINER

LEVEL

MBq/100

cm

2

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%

INDIVIDUAL

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AND

ACTIVITY

(MBq) AND

Stable

DESCRIP-

WASTE

STABILIZATION,

CHEMICAL

FORM/

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CONTAINER

TOTAL;

OR

CONTAINER

TOTAL

ACTIVITY

AU-Class

A

GENERATOR

3

WEIGHT

CHELATING

AGENT

Unstable

(See

Note

1)

(

(,Sv/hr)

BETA-

TOR

VOLUME(S)

IN

CHELATINGNAGENTUUnstable

ID NUMBER(S)

(kg)

ALPHA

GAMMA

Note

2)

CONTAINER

MEDIA

AGENT

AND RADIONUCLIDE

PERCENT

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APPROVED

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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

of

low-level

EXPIRES:

513112001

waste.

Forward

comments

regarding

burden

estimate

to

the

Records

Management

Branch

(T-6

F33), U.S.

Nuclear

Regulatory

Commission,

Washington,

DC

20555-0001,

and

to

the

Paperwork

Reduction

Project

(3150-0165),

Office

of

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and

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NRC

FORM

542

U.S.

NUCLEAR

REGULATORY

COMMISSION

2.

MANIFEST

NUMBER

(5-1998)

WASTE

COLLECTOR/PROCESSOR

UNIFORM

LOW-LEVEL

RADIOACTIVE

NAME

SHIPPER

USE

ONLY

WASTE

MANIFEST

IDEN11FICAT10N

NUMBER

MANIFEST

INDEX

AND

REGIONAL

COMPACT

TABULATION

3.

List

all

original

"PROCESSED

WASTE"

generators

(if

any)

SHIPPING

DATE

PAGE

1

OF

PAGE(S)

before

"COLLECTED

WASTE"

generators.

_1

4.

5.

6.

7.

8.

9.

10.

11.

AS

PROCESSED/COLLECTED

TOTAL

PREPROCESSED

GENERATOR

GENERATOR

NAME,

GENERATOR

WASTE

MANIFEST

NUMBER(S)

UNDER

WASTE CODE

ORIGINATING

A.SOURCE

IDENTIFICATION

PERMIT

NUMBER

(IF

APPLICABLE),

FACILITY

(OR

MATERIAL)

WHICH

WASTE

(OR

MATERIAL)

P

=

PROCESSED

COMPACT

AB.SNM

C.

ACTIVITY

S.

VOLUME

NUMBER

AND

TELEPHONE

NUMBER

ADDRESS

VOLUME

RECEIVED

AND

DATE

C

=

COLLECTED

REGION

STTERIAL

[

m

3

)

OF

RECEIPT

OR

STATE

kg)

(g)

(MBq)

(m3

4

r

I

I

r

I

T

I

4

4

¶

1

1

1

I

I

I

T

4

4

t

1

1

1

I

I

I

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4

4

1

I

t

1

I

I

I

T

I

4

1

I

1

I

1

1

1

I

I

4

I

4

4

1

1

1

1

_______________________

__________________________

1

1

1

1

1

TOTALS

OF

ALL

PAGES

(NRC

FORMS

542

AND

542A)

______________________

i

i

I

NRC

FORM

542

(5-1998)

NRC

FORM

642A

U.S.

NUCLEAR

REGULATORY

COMMISSION

2.

MANIFEST

NUMBER

(395

UNIFORM

LOW-LEVEL

RADIOACTIVE

WASTE

MANIFEST

3.

MANIFEST

INDEX

AND

REGIONAL

COMPACT

TABULATION

(CONTINUATION)

IPAGE

_

OF

PAGE(S)

4.

5.

8.

7.

8.

9.

10.

11.

AS

PROCESSEDICOLLECTED

TOTAL

PREPROCESSED

GENERATOR

GENERATOR

NAME,

GENERATOR

WASTE

MANIFEST

NUMBER(S)

UNDER

WASTE

CODE

ORIGINATING

(OR

MATERIAL)

WHICH

WASTE

(OR

MATERIAL)

P

=

PROCESSED

COMPACT

A.SSOURCE

IDENTIFICATION

PERMIT

NUMBER

(IF

APPLICABLE),

FACILITY

VOUERCIE

N

AE

P=POESD

REGION

MATERIAL

B.

SNM

C.

ACTIVITY

D.

VOLUME

NUMBER

AND

TELEPHONE

NUMBER

ADDRESS

VOLUME

RECEIVED

AND

DATE

C

=

COLLECTED

OR STATE

MATE

L3

(m,

3

)

OF

RECEIPT

ORSAE(kg)

(g)

(MBq.)

(m3

Federal

Recycling

Program

I