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NUCLEAR MATERIAL TRANSACTION REPORT
1. SHIPPER'S RIS
2. RECEIVER'S RIS
3. TRANSACTION NO.
4. CORRECTION NO.
5. PROCESSING CODE
a. SHIPPER
8.a. NAME AND ADDRESS
OF SHIPPER
b. LICENSE
NO.
9.a. NAME AND ADDRESS
OF RECEIVER
b. LICENSE
NO.
7. DOCUMENTATION (Only if document is classified SECRET)
6. ACTION CODE
b. RECEIVER
a. SHIPPER
b. RECEIVER
10. NO OF DATA LINES
PAGE
OF
PAGES
COPY
OF
11. NATURE OF TRANSACTION
12.a. SHIPPED FOR ACCOUNT OF
NO.
13.a. SHIPPED TO ACCOUNT OF
b. RIS
COPIES
b. RIS
SERIES
DISTRIBUTION OF COPIES
1
2
3
4
c. ATTENTION:
c. ATTENTION:
d. TELEPHONE:
d. TELEPHONE:
5
14. TRANSFER AUTHORITY - CONTRACT, NM DRAFT, OR ORDER NUMBER
6
15. EXPORT OR IMPORT TRANSFERS: LICENSE NO.
7
16. MATERIAL TYPE AND DESCRIPTION
17.
18.
19.
20.
21.
LINE
NUMBER
COUNTRY OF
OBLIGATION
MATERIAL
TYPE
OBLIGATED
ELEMENT WEIGHT
OBLIGATED ISOTOPE
WEIGHT
For Enriched Uranium Only
8
9
MONTH DAY
(MM)
(DD)
22. ACTION DATE
YEAR
(YYYY)
a. SHIPMENT
23a. MISCELLANEOUS
b. SHIPPER'S CORRECTION
b. CONCISE NOTE ATTACHED
c. UK REPORTABLE?
YES
c. RECEIPT
NO
d. RECEIVER'S MEASUREMENT
e. RECEIVER'S CORRECTION
26. SHIPPER'S DATA
24. TOTAL GROSS WEIGHT
BACK
REFERENCE
NUMBER
LINE
NO.
TYPE
OF INV.
CHANGE
IDENTIFICATION
(ITEM/BATCH NAME)
NO. OF
ITEMS
PROJECT
NUMBER
MATERIAL
TYPE
a.
b.
c.
d.
e.
f.
g.
SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED
h.
i.
KEY
MEAS.
POINT
j.
MEAS. IDENT.
k.
1
BASIS
2
OMP
3
METHOD
GROSS WEIGHT
NET WEIGHT
ELEMENT
WEIGHT
ELEMENT
LIMIT OF
ERROR
WEIGHT %
ISOTOPE
ISOTOPE
WEIGHT
ISOTOPE
LIMIT OF
ERROR
l.
m.
n.
o.
p.
q.
r.
27s. RECEIVER'S DATA
SIGNATURE OF AUTHORIZED OFFICIAL AND DATE SIGNED
27. RECEIVER'S DATA
26s. SHIPPER'S DATA
COMP/ OWNER
FACILITY CODE
CODE
25. TOTAL VOLUME (Waste Transfers Only)
WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC
BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR
REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
DOE/NRC FORM 741 (MM-DD-YYYY)
| File Type | application/pdf |
| File Title | c:\temp\ffdah1.wpf |
| Author | dah1 |
| File Modified | 2023-07-28 |
| File Created | 2023-02-28 |