NRC Form 542A 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 17th Street 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
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U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 542A
(MM-YYYY)

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST

MANIFEST INDEX AND REGIONAL COMPACT TABULATION (Continuation)
See NUREG/BR-0204 for detailed instructions for completing this form: http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/
4.

Generator
Identification
Number

NRC FORM 542A (MM-YYYY)

2. Manifest Number

5.

Generator Name
Permit Number (If Applicable)
and Telephone Number

6.

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

3. Page

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
Number if applicable)
(m 3)