541 NRC Form 541

APPROVED BY OMB: NO. 3150-0166
EXPIRES: MM/DD/YYYY

Estimated burden per response to comply with this information collection reques t: 3.3 hours. This uniform manifest is required by NRC to meet reporting requi rements of Federal and State Agencies for the safe transportation and disposal of low-level waste. Send comments regarding burden
estimate to the Records and FOIA/Privacy Service Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to in focollects.resource@nrc.gov, 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 impose an information collection does not display a currently vaild OMB control number, t he NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC FORM 541

2. MANIFEST NUMBER

1. MANIFEST TOTALS

U.S. NUCLEAR REGULATORY COMMISSION
NUMBER OF
PACKAGES/
DISPOSAL
CONTAINERS

(M-YYYY)

NET WASTE
VOLUME
(m 3)

NET WASTE
WEIGHT
(kg)

SPECIAL NUCLEAR MATERIAL (grams)
U-233

U-235

Pu

TOTAL

3.

PAGE

UNIFORM LOW-LEVEL RADIOACTIVE
WASTE MANIFEST
ALL NUCLIDES

TRITIUM

PAGE(S)

4. SHIPPER NAME

ACTIVITY (MBq)

CONTAINER AND WASTE DESCRIPTION

OF

C-14

Tc-99

SOURCE
(kg)

I-129

SHIPPER I.D. NUMBER

Additional Nuclear Regulatory Commission (NRC) Requirements for Control, Transfer and
Disposal of Rdioactive Waste

DISPOSAL CONTAINER DESCRIPTION
5.

7.

6.
CONTAINER
IDENTIFICATION
NUMBER/
GENERATOR
ID NUMBER(S)

CONTAINER
DESCRIPTION

8.
VOLUME
(m 3)

(See Note 1)

9.

WASTE
AND
CONTAINER
WEIGHT
(kg)

WASTE DESCRIPTION FOR EACH WASTE TYPE IN CONTAINER
10.

SURFACE
RADIATION
LEVEL

(µSv/hr)

SURFACE
CONTAMINATION
MBq/100cm 2

ALPHA

(mSv/hr)

NOTE 1: Container Description Codes. For containers/
waste requiring disposal in approved structural overpacks,
the numerical code must be followed by "-OP."
1.
2.
3.
4.
5.
6.
7.
8.

Wooden Box or Crate
Metal Box
Plastic Drum or Pail
Metal Drum or Pail
Metal Tank or Liner
Concrete Tank or Liner
Polyethylene Tank or Liner
Fiberglass Tank or Liner

NRC FORM 541 (M-YYYY)

9.
10.
11.
12.
13.
19.

Demineralizer
Gas Cylinder
Bulk Unpackaged Waste
Unpackaged Components
High Integrity Container
Other. Describe in item 6,
or additional page

BETAGAMMA

PHYSICAL DESCRIPTION
11.
12.
WASTE
APPROXIMATE
DESCRIPWASTE
TOR
VOLUME(S) IN
CONTAINER
(See Note 2)

14.

13.

SORBENT
SOLIDIFICATION,
STABILIZATION,
MEDIA

Charcoal
Incinerator Ash
Soil
Gas
Oil
Aqueous Liquid
Filter Media
Mechanical Filter
EPA or State Hazardous

29.
30.
31.
32.
33.
34.
35.
36.
37.

Demolition Rubble
Cation Ion-exchange Media
Anion Ion-exchange Media
Mixed Bed Ion-exchange Media
Contaminated Equipment
Organic Liquid (except oil)
Glassware or Labware
Sealed Source/Device
Paint or Plating

38.
39.
40.
41.
42.
43.
59.

Evaporator Bottoms/Sludges/Concentrates
Compactible Trash
Noncompactible Trash
Animal Carcass
Biological Material (except animal carcass)
Activated Material
Other. Describe in item 11,
or additional page

RADIOLOGICAL DESCRIPTION

15.
WEIGHT
%
CHELATING
AGENT
IF > 0.1%

CHEMICAL FORM/
CHELATING AGENT

(See Note 3)

NOTE 2: Waste Descriptor Codes. (Choose up to three which predominate by volu me.)
20.
21.
22.
23.
24.
25.
26.
27.
28.

CHEMICAL DESCRIPTION

INDIVIDUAL RADIONUCLIDES AND ACTIVITY (MBq) AND
CONTAINER TOTAL; OR CONTAINER TOTAL ACTIVITY
AND RADIONUCLIDE PERCENT

16.
WASTE
CLASSIFICATION
AS-Class A
Stable
AU-Class A
Unstable
B-Class B
C-Class C

NOTE 3: For solidification media that meet disposal site structural stability r equirements, the numerical code must be followed by "-S."
For all solidification media, the vendor (manufacturer) and brand name must also be identified in item 13. Code 100=NONE REQUIRED.

Sorption
60. Speedi Dri
61. Celetom
62. Floor Dry/
Superfine
63. Hi Dri

Solidification
64.
65.
66.
67.
68.

Safe T Sorb
Safe N Dri
Florco
Florco X
Solid A Sorb

69.
70.
71.
72.
73.

Chemsil 30
Chemsil 50
Chemsil 3030
Dicaperl HP200
Dicaperl HP500

74.
75.
76.
77.

Petroset
Petroset II
Aquaset
Aquaset II

89. Other.
Describe in
item 13, or
additional
page

90. Cement
91. Concrete
(encapsulation)
92. Bitumen
93. Vinyl Chloride

94. Vinyl Ester Styrene
99. Other. Describe
in item 13, or
additional page
100. None Required