540A NRC Form 540A

APPROVED BY OMB: NO. 3150-0164
EXPIRES: (MM/DD/YYYY)

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 internet e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0164),
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.

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 540A
(MM-YYYY)

UNIFORM LOW-LEVEL RADIOACTIVE
WASTE MANIFEST
SHIPPING PAPER (CONTINUATION)

11.

8. MANIFEST NUMBER
(Use this number on all continuation pages)

U.S. DEPARTMENT OF TRANSPORTATION DESCRIPTION
(Including proper shipping name, hazard class, UN ID number,
and any additional information)

NRC FORM 540A (MM-YYYY)

12.

DOT LABEL
"RADIOACTIVE"

13.
TRANSPORT
INDEX

14.

PHYSICAL AND
CHEMICAL FORM

15.

PAGE
INDIVIDUAL RADIONUCLIDES

16.
17.
TOTAL PACKAGE
ACTIVITY IN SI UNITS

LSA/SCO
CLASS

OF

18. TOTAL WEIGHT
OR VOLUME
(Use appropriate units)

PAGE(S)
19. IDENTIFICATION
NUMBER OF
PACKAGE