Form NRC Form 541 NRC Form 541 Uniform Low-Level Radioactive Waste Manifest Container a

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

Estimated burden per response to comply with this information collection request: 3.3 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 Information Services Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@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 valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC FORM 541

U.S. NUCLEAR REGULATORY COMMISSION

(MM-YYYY)

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST
CONTAINER AND WASTE DESCRIPTION

1. MANIFEST TOTALS
NUMBER OF
PACKAGES/
DISPOSAL
CONTAINERS

NET WASTE
VOLUME
(m 3)

NET WASTE
WEIGHT
(kg)

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

2. MANIFEST NUMBER

SPECIAL NUCLEAR MATERIAL (grams)
U-233

U-235

Pu

TOTAL

ACTIVITY (MBq)
ALL NUCLIDES

TRITIUM

C-14

Tc-99

SOURCE
(kg)

I-129

Instructions: 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

6.

5.
CONTAINER
IDENTIFICATION
NUMBER/
GENERATOR
ID NUMBER(S)

7.

CONTAINER
DESCRIPTION
(See Note 1)

8.

VOLUME
(m 3)

WASTE
AND
CONTAINER
WEIGHT
(kg)

NOTE 1: Container Description Codes. For containers/
waste requiring disposal in approved structural overpacks,
the numerical code must be followed by "-OP."
1. Wooden Box or Crate
2. Metal Box
3. Plastic Drum or Pail
4. Metal Drum or Pail
5. Metal Tank or Liner
6. Concrete Tank or Liner
7. Polyethylene Tank or Liner
8. Fiberglass Tank or Liner

9. Demineralizer
10. Gas Cylinder
11. Bulk Unpackaged Waste
12. Unpackaged Components
13. High Integrity Container
19. Other. Describe in item 6,
or additional page

NRC FORM 541 (MM-YYYY)

9.

SURFACE
RADIATION
LEVEL

(µSv/hr)

10.

SURFACE
CONTAMINATION
MBq/100cm 2

ALPHA

(mSv/hr)

BETAGAMMA

PAGE

OF

PAGE(S)

4. SHIPPER NAME

SHIPPER I.D. NUMBER

WASTE DESCRIPTION FOR EACH WASTE TYPE IN CONTAINER
PHYSICAL DESCRIPTION
12.
11.
WASTE
APPROXIMATE
DESCRIPWASTE
TOR
VOLUME(S) IN
CONTAINER
(See Note 2)

14.

13.
SORBENT
SOLIDIFICATION,
STABILIZATION,
MEDIA

29. Demolition Rubble
30. Cation Ion-exchange Media
31. Anion Ion-exchange Media
32. Mixed Bed Ion-exchange Media
33. Contaminated Equipment
34. Organic Liquid (except oil)
35. Glassware or Labware
36. Sealed Source/Device
37. Paint or Plating

CHEMICAL DESCRIPTION

38. Evaporator Bottoms/Slud ges/Concentrates
39. Compactible Trash
40. Noncompactible Trash
41. Animal Carcass
42. Biological Material (except animal carcass)
43. Activated Material
59. Other. Describe in item 11,
or additional page

RADIOLOGICAL DESCRIPTION

15.
WEIGHT
%
CHELATING
AGENT
IF > 0.1%

CHEMICAL FORM/
CHELATING AGENT

(See Note 3)

NOTE 2: Waste Descriptor Codes. (Choose up to three which predominate by volume.)
20. Charcoal
21. Incinerator Ash
22. Soil
23. Gas
24. Oil
25. Aqueous Liquid
26. Filter Media
27. Mechanical Filter
28. EPA or State Hazardous

3.

INDIVIDUAL RADIONUCLIDES AND ACTIVITY (MBq) AND
CONTAINER TOTAL; OR CONTAINER TOTAL ACTIVITY
AND RADIONUCLIDE PERCENT

16.
WASTE
CLASSIFICATION
AS-Class A
Stable
AU-Class A
Unstable
B-Class B
C-Class C

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
60. Speedi Dri
61. Celetom
62. Floor Dry/
Superfine
63. Hi Dri

Solidification
64.
65.
66.
67.
68.

Safe T Sorb
Safe N Dri
Florco
Florco X
Solid A Sorb

69. Chemsil 30
70. Chemsil 50
71. Chemsil 3030
72. Dicaperl HP200
73. Dicaperl HP500

74.
75.
76.
77.

Petroset
Petroset II
Aquaset
Aquaset II

89. Other.
Describe in
item 13, or
additional
page

90. Cement
91. Concrete
(encapsulation)
92. Bitumen
93. Vinyl Chloride

94. Vinyl Ester Styrene
99. Other. Describe
in item 13, or
additional page
100. None Required