NRC Form 541A Uniform Low-Level Waste Radioactive Waste Manifest Conta

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

NRC FORM 541A
(MM-YYYY)

Estimated burden per response to comply with this information collection request: 3.3 hours. 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, (3150-0166), 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
collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.
U.S. NUCLEAR REGULATORY COMMISSION

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST

2. Manifest Number
(Use this number on all continuation pages)

CONTAINER AND WASTE DESCRIPTION (Continuation)

See NUREG/BR-0204 for detailed instructions for completing this form: http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/
Disposal Container Description
5. Container
6. Container
7. Volume 8. Waste
9. Waste
10.
Surface
3
Identification
Description
(m )
and
Weight
Radiation Level
Number/Generator
(See Note 1)
Container
(kg)
(µSv/hr)
ID Number(s)
Weight (kg)

(mSv/hr)

NRC FORM 541A (MM-YYYY)

11. Surface
Contamination
2
MBq/100 cm
Alpha

BetaGamma

3.

Page

Of

Page(s)

Waste Description for Each Waste Type in Container
Physical Description
15. Chemical Description
16. Radiological Description
17. Waste Class
AS-Class A Stable
12. Waste 13. Approximate 14. Sorbent
AU-Class A Unstable
Weight
Individual Radionuclides and Activity
Descriptor
Waste
Solidification,
Chemical Form/
B-Class B
% Chelating
(MBq) and Container Total; or Container
(See Note 2) Volume(s) in
Stabilization,
Chelating Agent
C-Class C
Agent if > 0.1%
Total Activity and Radionuclide Percent
Container
Media (See Note 3)