ATTACHMENT E TRANS VEH REQUEST FORM.pdf

Document No. 4037V100 Attachment (E)

ATTACHMENT (E)

NO

YES

YES

TRANSPORT VEHICLE REQUEST FORM

DOCUMENT NUMBER N42158-

RAM SPECIALIST WADE EVERETTE PHONE NO. (757) 396-2398

JOB ORDER TBD CONTRACT NUMBER TBD

DELIVERY ORDER TBD

DATE VEHICLE REQUIRED WITHIN 6 WEEKS AFTER BEING NOTIFIED BY NORFOLK NAVAL SHIPYARD (NNSY)

TIME VEHICLE REQUIRED 6:00 AM, OR AS PERMITS ALLOW

REQUIRED REPORTING AND/OR LOADING LOCATION AND INSTRUCTIONS NORFOLK NAVAL SHIPYARD (NNSY), PORTSMOUTH, VA 23709

FINAL OUTBOUND DESTINATION WESTINGHOUSE, 680 WALTZ MILL ROAD, RUFFS DALE, PA 15663

DATE OF SCHEDULED SHIPMENT TBD DATE TO BE DELIVERED TBD

SHIPMENT DESCRIPTION:

RADIOACTIVE / NO HAZARDOUS WASTE YES /

PROPER SHIPPING NAME(s) UN2913, RADIOACTIVE MATERIAL, SURFACE CONTAMINATED OBJECTS (SCO-I), 7

CONTAINER TYPE(S) & DIMENSIONS 1 EACH METAL CONTAINER - 225 INCHES LONG X 121 INCHES WIDE X 106

INCHES HIGH

TOTAL SHIPMENT WEIGHT 54,431 KILOGRAMS (120,000 POUNDS)

HIGHEST RADIATION LEVEL TBD ACTIVITY TBD

LABELS APPLIED YES / LABELS N/A TRANSPORT INDEX TBD

RADIOLOGICAL REQUIREMENTS INVOKED / NO (If YES, see attached Radiological Requirements) (Only required for Exclusive Use non-contract vehicles)

VEHICLE REQUIREMENTS:

VEHICLE TYPE Van Flatbed Stakebody Dropdeck Curtain _X_ Heavy Haul

WOOD DECK / NO D-RINGS IN DECK YES / ISO LOCKS YES /

INSPECTION CRITERIA

A. SEE ATTACHED VEHICLE ASSESSMENT CHECKLIST PERTAINING TO NNSY INSPECTION REQUIREMENTS.

EQUIPMENT REQUIRED TO ARRIVE WITH VEHICLE:

TARPS REQUIRED YES / NO QTY AS REQUIRED MINIMUM SIZE COVER ENTIRE CONTAINER, EXCEPT THE BOTTOM AND NEAR

SAFETY HOIST RINGS AND OR PADEYES

CHAINS/BINDERS

SKETCH)

/ NO QTY 12 MINIMUM SIZE AND GRADE 1/2 INCH GRADE 8 (SEE ATTACHED TIE-DOWN

STRAPS / NO QTY 4 MINIMUM SIZE /4” CHAFFING GEAR / NO QTY AS REQUIRED

OTHER REQUIRED N/A

NO NO

YES

YES

YES

YES

INITIAL FOR REVIEW

YES

EQUIPMENT CRITERIA

A. ALL DESIGNATED EQUIPMENT SHALL BE EITHER “NEW” OR IN “LIKE NEW” CONDITION (FOR EXAMPLE, TARPS, STRAPS, AND CHAINS).

B. RATCHET STRAP BOLTS SHALL BE CHECKED AND VERIFIED TO BE (1) GRADE 5 OR ABOVE AND (2) MARKED WITH

A VALID MANUFACTURER’S SYMBOL ON THE HEAD.

PERMITS REQUIRED:

RADIOACTIVE MATERIAL PERMIT / NO (If YES, provide copies of permits.)

DIMENSIONAL/OVERWEIGHT PERMIT

registration.)

/ NO (If YES, provide empty weight of tractor & trailer and provide copy of trailer

HAZARDOUS WASTE TRANSPORT PERMIT YES /

applicable states.)

HAZARDOUS MATERIAL TRANSPORT PERMIT YES /

all applicable states.)

(If YES, provide copies of Hazardous Waste Transport permits for all

(If YES, provide copies of Hazardous Material Transport permits for

RADIOACTIVE WASTE TRANSPORT PERMIT / NO (If YES, provide copies of permits.)

ALL REQUIRED PERMITS SHALL BE PROVIDED TO NNSY POC FOR REVIEW AT ANY TIME PRIOR TO RELEASE OF

SHIPMENT.

MATERIAL DESCRIPTION FOR PERMIT(S) WHEN REQUIRED RADIOACTIVELY CONTAMINATED PUMP

WHEN CHECKED SEE ATTACHED TIE-DOWN SKETCH

GENERAL REQUIREMENTS:

PLACARDS REQUIRED / NO EXCLUSIVE USE OF VEHICLE REQUIRED / NO

EXPEDITED SERVICE REQUIRED YES / HAND TO HAND SIGNATURE SERVICE REQUIRED / NO

CONSTANT SURVEILLANCE YES / DUAL DRIVERS YES /

CARRIER/DRIVER REQUIREMENTS

A. DAILY CHECK-IN IS REQUIRED (FOR LOADS IN-TRANSIT GREATER THAN 1 DAY) BY CALLING (757) 396-3037.

B. IDENTIFY STATES FROM ORIGINATION TO DESTINATION IN THE “ROUTING” SECTION BELOW.

C. WE WILL BE NAILING TO WOODEN DECK AS REQUIRED.

D. CARRIER SAFETY AND INSPECTION RATING SHALL BE “SATISFACTORY” AND ALL 3 OUT OF SERVICE (OOS) VALUES, SPECIFICALLY “VEHICLE”, “DRIVER”, AND “HAZMAT”, SHALL BE BELOW THEIR CORRESPONDING NATIONAL AVERAGE

PERCENTAGES BY AT LEAST 25%.

ROUTING PER PERMIT

SOLE USE OF ALL CONVEYANCES SHALL BE DEDICATED TO NNSY / NO YES

NO

NO

NO

NO

YES

YES YES

OTHER _N/A

NNSY RESERVES THE RIGHT TO REFUSE CARRIER IF REQUIREMENTS ARE NOT MET

SUBMISSION OF FORM

*CODE 2380.9 RAM SPECIALIST WADE EVERETTE 078724_ DATE TBD

REQUEST FORM COMPLETED SAT SIGN/BADGE NO.

SUBMITTED TO DAVID LOVE CODE 2305 PHONE (757) 396-3061

POINT OF CONTACT (FOR INFO ONLY)

RESPONSE TO SUBMISSION (CARRIER PROVIDING VEHICLE)

1. TRANSPORT VEHICLE HAS BEEN SCHEDULED TO ARRIVE AT REQUIRED DATE AND TIME.

A. DESIGNATED EQUIPMENT, INCLUDING ALL REQUESTED TIE-DOWN MATERIAL, IS CONFIRMED AND REQUIREMENTS

ARE UNDERSTOOD AND SHALL BE MET.

B. I HAVE READ, UNDERSTAND, AND SHALL COMPLY WITH THE REQUIREMENTS AS NOTED ABOVE.

C. CAMERAS AND CELL PHONE CAMERAS ARE NOT ALLOWED EITHER AT PIER 11S OR IN ANY OTHER NSN POSTED

AREA.

DATE

CARRIER REPRESENTATIVE SIGNATURE

EPA NUMBER WHEN APPLICABLE N/A

2. TRANSPORT VEHICLE HAS BEEN SCHEDULED TO ARRIVE AT REQUIRED DATE AND TIME.

CONFIRMATION FROM CARRIER IS ATTACHED (N/A FOR HAZARDOUS WASTE VEHICLES).

DATE

DLA TRANSPORTATION OFFICE

COMPLETION OF REVIEW BY 2380.9 RAM SPECIALIST

COMPLETED FORM AND CONFIRMATION DOCUMENTATION (IF REQUIRED) HAS BEEN REVIEWED SAT.

COMPLETED FORM FILED IN SHIPPING PAPER PACKAGE.

*CODE 2380.9 RAM SPECIALIST DATE

REVIEW SAT SIGN/BADGE NO.

* The person designated to sign for an action verifies, based on personal observation, and certifies by signature that the action has actually been performed in accordance with the specified requirements.

RADIOLOGICAL REQUIREMENTS:

A. In addition to the requirements of Federal, State, and Local regulatory authorities and those specific requirements stipulated in applicable licenses, permits, and authorizations, the below stated radiological requirements apply, as indicated.

(1) Freight carrier vehicles used for transporting NNSY material, including equipment supplied with the vehicle to secure the load (for example, chain binders or cargo straps), shall not be used to transport or provide for the transport of NNSY materials unless these vehicles and equipment are surveyed by the freight carrier prior to departure from the freight carrier’s facility and meet the limits of paragraphs B (1), B (2), and B (3) below.

B. Vehicles used for transporting NNSY material and other equipment shall be surveyed and show compliance with the applicable paragraph, as follows:

(1) Loose radioactive contamination on internal and external surfaces shall not exceed 450 Ci/probe Beta-Gamma (- ) when frisked with a ratemeter equipped with a DT-304/PDR probe, or instrument of equal sensitivity, or 450 Ci/100 square centimeters Beta-Gamma (-) as measured with dry swipes counted with a ratemeter equipped with a DT-304/PDR probe, or instrument of equal sensitivity, or 50 Ci/probe Alpha () as measured with an AN/PDR-56, or equivalent instrument.

(2) Fixed radioactivity on internal and external surfaces shall not exceed 450 Ci/probe Beta-Gamma (-) as measured with a ratemeter equipped with a DT-304/PDR probe, or instrument of equivalent sensitivity, and shall not exceed 50 μμCi/probe Alpha (α) as measured with an AN/PDR-56 instrument, or an instrument of equivalent sensitivity.

(3) Transport vehicles and equipment shall not exceed 450 Ci/probe Beta-Gamma (-) when frisked with a ratemeter equipped with a DT-304/PDR probe, or instrument of equal sensitivity, or 50 Ci/probe Alpha () when surveyed with an AN/PDR-56, or instrument of equivalent sensitivity.

C. Freight carrier vehicles or equipment used for transporting NNSY material that are found to be above the limits specified above shall, at the option of NNSY, be returned at freight carrier expense to the freight carrier for decontamination, or be decontaminated by NSN at freight carrier expense. If the return of the vehicle or equipment would result in a violation of Federal, State, or Local regulations, the freight carrier shall be notified in advance of the extent of the work to be performed by NSN and the estimated cost. No on-site decontamination by freight carrier personnel shall be permitted. No detention and demurrage charges shall accrue during the period the vehicle, or equipment, are being detained, or decontaminated, by NSN.

D. The following radiation measuring methods shall be used to determine the various radiation and or contamination levels:

(1) Gamma () radiation fields shall be measured with an IM-265/PDQ radiac meter with DT680/PDQ Beta-Gamma (-) probe, or Teletector model 6112 (IM-260/PD), or equivalent instrument, as applicable, calibrated to Cobalt-60 equivalent.

(2) Beta-Gamma (-) swipes shall be measured within 1/2 inch with a Geiger tube type instrument, or E-140N (IM- 254/UD) equipped with a DT-304/PDR probe, or equivalent, as applicable, calibrated to Cobalt-60 equivalent.

(3) Alpha () activity swipes shall be measured with an AN/PDR-56 Alpha survey meter, or equivalent.

(4) Swipes shall be taken dry over an area of 100 square centimeters using a 1-1/8 inch diameter filter, or paper, disc.

(5) Frisk surveys shall be performed with a DT-304/PDR equipped ratemeter, or instrument of equal sensitivity, with the probe held within 1/2 inch of the surface being scanned.

(6) NNSY shall perform surveys to verify compliance with 49 CFR Part 173.441 and with the conditions and limits specified in the Contract.