NRC-541_Form.pdf

NOTE 1: Container Description Codes. For containers/ waste requiring disposal in approved structural overpacks, the numerical code must be followed by "-OP."

UNIFORM LOW-LEVEL RADIOACTIVE

WASTE MANIFEST

NRC FORM 541

(7-2001)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 541 (7-2001)

APPROVED BY OMB: NO. 3150-0166

EXPIRES: 07/31/2004

CONTAINER AND WASTE DESCRIPTION

SHIPPER I.D. NUMBER

2. MANIFEST NUMBER

4. SHIPPER NAME

Additional Nuclear Regulatory Commission (NRC) Requirements for Control, Transfer and Disposal of Rdioactive Waste

PAGE(S)PAGE OF

3.

1. MANIFEST TOTALS

NUMBER OF

PACKAGES/

DISPOSAL

CONTAINERS

NET WASTE

VOLUME

(m )

NET WASTE

WEIGHT

(kg)

SPECIAL NUCLEAR MATERIAL (grams)

U-233 U-235 Pu TOTAL

ACTIVITY (MBq) SOURCE (kg)ALL NUCLIDES TRITIUM C-14 Tc-99 I-129

1. Wooden Box or Crate Metal Box2.

Plastic Drum or Pail3.

Metal Drum or Pail4.

Metal Tank or Liner5.

Concrete Tank or Liner6. Polyethylene Tank or Liner

7.

Fiberglass Tank or Liner8.

9. Demineralizer Gas Cylinder10

. Bulk Unpackaged Waste11

. Unpackaged Components12

. High Integrity Container13

. Other. Describe in item 6, or additional page

Charcoal Incinerator Ash21

. Soil22

. Gas23

. Oil24

. Aqueous Liquid25

. Filter Media26

. Mechanical Filter27

. EPA or State Hazardous

Demolition Rubble Cation Ion-exchange Media30

. Anion Ion-exchange Media31

. Mixed Bed Ion-exchange Media

. Contaminated Equipment33 . Organic Liquid (except oil)34 . Glassware or Labware35 . Sealed Source/Device36 . Paint or Plating37

40.

38. Evaporator Bottoms/Sludges/ConcentratesCompactible Trash39.

Noncompactible Trash Animal Carcass41. Biological Material (except animal carcass)

42.

Activated Material43.

Other. Describe in item 11, or additional page

59.

Chemsil 5071

Chemsil 3070 . Chemsil 3030

Dicaperl HP20072 . Dicaperl HP50073

Petroset74 . Petroset II75 . Aquaset76 . Aquaset II77

Celetom62

Speedi Dri61 . Floor Dry/

Superfine Hi Dri63

Safe T Sorb64 . Safe N Dri65 . Florco66 . Florco X67 . Solid A Sorb68

Other. Describe in item 13, or additional page

94. Vinyl Ester Styrene99.

None Required100

89. Other.

Describe in item 13, or additional page

Cement90 . Concrete

(encapsulation)

Bitumen92 . Vinyl Chloride93

NOTE 2: Waste Descriptor Codes. (Choose up to three which predominate by volume.) NOTE 3: For solidification media that meet disposal site structural stability requirements, the numerical code must be followed by "-S."

For all solidification media, the vendor (manufacturer) and brand name must also be identified in item 13. Code 100=NONE REQUIRED.

Sorption Solidification

Estimated burden per response to comply with this information collection request: 2 hours. This uniform manifest is required by NRC to meet reporting requirements of Federal and State Agencies for the safe transportation and disposal of low-level waste. Send comments regarding burden estimate to the Records Management Branch (T-6 E6), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to bjs1@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0166), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently vaild OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

WASTE DESCRIPTION FOR EACH WASTE TYPE IN CONTAINERDISPOSAL CONTAINER DESCRIPTION

5.

CONTAINER

IDENTIFICATION

NUMBER/

GENERATOR

ID NUMBER(S)

CONTAINE

R

DESCRIP-

TION

(See Note 1)

6.

VOLUME

(m )

WASTE

AND

CONTAINER

WEIGHT

(kg)

SURFACE

RADIATION

LEVEL

SURFACE

CONTAMINATION

7. 8. 9. 10.

(µSv/hr) ALPHA

2MBq/100cm

(mSv/hr)

BETA-

GAMMA

WASTE

CLASSIFI-

CATION

AS-Class A Stable

AU-Class A Unstable B-Class B C-Class C

16.

WASTE

DESCRIP-

TOR

(See Note 2)

11.

APPROXIMATE

WASTE

VOLUME(S) IN

CONTAINER

12. 13.SORBENT

SOLIDIFICATION,

STABILIZATION,

MEDIA

(See Note 3)

CHEMICAL FORM/

CHELATING AGENT

14.

WEIGHT

CHELATING

AGENT

IF > 0.1%

PHYSICAL DESCRIPTION CHEMICAL DESCRIPTION RADIOLOGICAL DESCRIPTION15.

INDIVIDUAL RADIONUCLIDES AND ACTIVITY (MBq) AND

CONTAINER TOTAL; OR CONTAINER TOTAL ACTIVITY

AND RADIONUCLIDE PERCENT

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