NRC Form 540A Uniform Low-Level Radioactive Waste Manifest (Shipping P

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 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

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

SHIPPING PAPER (CONTINUATION)
Instructions: See NUREG/BR-0204 for detailed instructions for completing this form: http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/
11.

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.

INDIVIDUAL RADIONUCLIDES

PAGE
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