DOE/NRC Form 742C DOE/NRC Form 742C, Physical Inventory Listing, CURRENT V

Page
DOE/NRC FORM 742C
(7-2008)
MANDATORY DATA COLLECTION
AUTHORIZED BY 10 CFR 30,
40, 50, 70, 72, 74, 75, 150,
Public Laws 83-703,
93-438, 95-91

U.S. DEPARTMENT OF ENERGY
AND
U.S. NUCLEAR REGULATORY COMMISSION

PHYSICAL INVENTORY LISTING

APPROVED BY OMB: NO. 3150-0058

EXPIRES: 05/31/2011

3. REPORTING IDENTIFICATION SYMBOL (RIS)

2. DOE/NRC FORM 740M ATTACHED

YES

STREET ADDRESS

STATE

Pages

Estimated burden per response to comply with this mandatory collection request: 6 hours. This information is required by NRC to fulfill its safeguards responsibilities, bilateral
agreements, and responsibilities as a participant in the US/IAEA Safeguards Agreement. Send comments regarding burden estimate to the Records and FOIA/Privacy Services Branch
(T-5 F52), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to infocollects@nrc.gov, and to the Desk Officer, Office of Information and
Regulatory Affairs, NEOB-10202, (3150-0058), Office of Management and Budget, Washington, DC 20503. If a means used to impose 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.

1. NAME AND ADDRESS

CITY

of

ZIP CODE

NO

4. INVENTORY DATE

5. PROCESS CODE

6. CORRECTION I.D.

7. LICENSE NUMBER(S)

8. BATCH DATA
a.
MATERIAL
TYPE

b.
COMP/FAC
CODE

c.
ELEMENT WEIGHT

d.
ISOTOPE WEIGHT

e.
DOE PROJECT NO.

f.
SCRAP
PROGRAM

g.
WEIGHT PERCENT ISOTOPE

h.
OWNER
CODE

i.
SEQUENCE
NUMBER

j.
BATCH NAME

k.
NO. OF
ITEMS

l.
KEY
MEASURE
POINT

m. MEASUREMENT I.D.
MEAS.
BASIS

OTHER MEAS.
POINT

MEAS.
METHOD

n.
ENTRY
STATUS

o.
MBA

p.
SITE
IDC

To the best of my knowledge and belief, the information given above and in any attached schedules is true, complete, and correct.
10. SIGNATURE

11. TITLE

12. DATE

WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN
ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES
AS TO ANY MATTER WITHIN ITS JURISDICTION.