NRC Form 541A Uniform Low-Level Radioactive Waste Manifest Container a

Estimated burden per response to comply with this information collection request: 3.3 hours. 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

APPROVED BY OMB: NO. 3150-0166
burden estimate to the Information Services Branch (T-6 A10M), 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, (3150-0166),
EXPIRES: (MM/DD/YYYY)
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.

NRC FORM 541A

U.S. NUCLEAR REGULATORY COMMISSION

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST

(MM-YYYY)

2. MANIFEST NUMBER

CONTAINER AND WASTE DESCRIPTION (CONTINUATION)

Instructions: See NUREG/BR-0204 for detailed instructions for completing this form: http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/
6.

5.
CONTAINER
IDENTIFICATION
NUMBER/
GENERATOR
ID NUMBER(S)

DISPOSAL CONTAINER DESCRIPTION

CONTAINER
DESCRIPTION
(See Note 1)

NRC FORM 541A (MM-YYYY)

7.

8.

VOLUME
(m 3)

WASTE
AND
CONTAINER
WEIGHT
(kg)

9.

SURFACE
RADIATION
LEVEL

(µSv/hr)
(mSv/hr)

10.

SURFACE
CONTAMINATION
MBq/100cm 2

ALPHA

BETAGAMMA

3.

PAGE

OF

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

14.

CHEMICAL DESCRIPTION

13.

SORBENT
SOLIDIFICATION,
STABILIZATION,
MEDIA
(See Note 3)

CHEMICAL FORM/
CHELATING AGENT

15.
WEIGHT
%
CHELATING
AGENT
IF > 0.1%

RADIOLOGICAL DESCRIPTION

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

PAGE(S)
16.
WASTE
CLASSIFICATION
AS-Class A
Stable
AU-Class A
Unstable
B-Class B
C-Class C