NRC Form 542 Uniform Low-Level Radioactive Waste Manifest Index and R

APPROVED BY OMB: NO. 3150-0165
EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this information collection request: 45 minutes. This uniform manifest or its equivalent is required by NRC to meet reporting requirements of Federal and State Agencies for the safe transportation and disposal of
low-level waste (10 CFR 20, App G). Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to
Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0165), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17Street NW, Washington, DC 20503; e-mail:
oira_submission@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.
U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 542

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST
MANIFEST INDEX AND REGIONAL COMPACT TABULATION
See NUREG/BR-0204 for detailed instructions for completing this form:
http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/

1. Waste Collector/Processor
Shipper Use Only

Name

Shipper ID Number

Shipping Date

3. Page

List all original "Processed Waste" generators (if any)
before "Collected Waste" generators.
4.

Generator
Identification
Number

NRC FORM 542 (MM-YYYY)

5.

Generator Name
Permit Number (If Applicable)
and Telephone Number

6.

2. Manifest Number

Generator
Facility
Address

7.

Preprocessed
Waste (or material)
Volume (m 3)

8.

Manifest Number(s) Under
Which Waste (or material)
Received and Date of Receipt

1

of

Page(s)

11. As processed/collected total
9.
10.
Waste Code
Originating Compact
B. SNM
C. Activity D. Volume
P = Processed Region or State (and Permit A. Source
Material (kg)
(g)
(MBq)
C = Collected
(m3 )
Number if applicable)