1. LICENSEE INFORMATION

NRC FORM 748

(05-22-2023)

10 CFR 20.2207

NATIONAL SOURCE TRACKING TRANSACTION REPORT

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

APPROVED BY OMB: NO. 3150-0202 EXPIRES: 05/31/2026

A. LICENSEE NAME B. LICENSE NO. C. LICENSEE STREET ADDRESS

A. NAME OF PREPARER B. DATE PREPARED C. PREPARER PHONE 

4. PREPARER INFORMATION

(Only transactions completed on the same

date may be reported together on this form) NEW CORRECTION

3B. TRANSACTION TYPE (Check all that apply)

REPORT SOURCE TRANSFER RECEIPT

DISASSEMBLE

DISPOSAL

NEW SOURCE 

MANUFACTURED

IF CORRECTION, PREVIOUS TRANSACTION DATE:

IMPORT EXPORT

D. PREPARER E-MAIL (REQUIRED FOR CONFIRMATION)

A1. SOURCE MAKE B1. SOURCE MODEL C1. SOURCE SERIAL

NUMBER

D1. ISOTOPE E1. ACTIVITY AND UNIT F1. ACTIVITY DATE G1. COMMENTS

H1. SOURCE LOCATION ADDRESS L1. SAME AS STREET

ADDRESS

2. TRANSACTION DATE 3A. TRANSACTION INFORMATION

D. CITY E. STATE F. ZIP CODE

I1. CITY J1. STATE K1. ZIP CODE

A2. SOURCE MAKE B2. SOURCE MODEL C2. SOURCE SERIAL

NUMBER

D2. ISOTOPE E2. ACTIVITY AND UNIT F2. ACTIVITY DATE G2. COMMENTS

H2. SOURCE LOCATION ADDRESS L2. SAME AS STREET

ADDRESS

I2. CITY J2. STATE K2. ZIP CODE

INVENTORY

5. SOURCE INVENTORY DATA (Note: Only use this section for reporting initial source inventory)

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.

Estimated burden per response to comply with this mandatory information collection request: 9.5 minutes. NRC requires this information to populate 

the National Source Tracking System for certain sealed sources. 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 email to Infocollects.Resource@nrc.gov, 

and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0202), Attn: Desk Officer for the Nuclear Regulatory 

Commission, 725 17th Street NW, Washington, DC 20503; email: 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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING 

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

5. SOURCE INVENTORY DATA (continued)

A3. SOURCE MAKE B3. SOURCE MODEL C3. SOURCE SERIAL

NUMBER

D3. ISOTOPE E3. ACTIVITY AND UNIT F3. ACTIVITY DATE G3. COMMENTS

H3. SOURCE LOCATION ADDRESS L3. SAME AS STREET

ADDRESS

I3. CITY J3. STATE K3. ZIP CODE

A4. SOURCE MAKE B4. SOURCE MODEL C4. SOURCE SERIAL

NUMBER

D4. ISOTOPE E4. ACTIVITY AND UNIT F4. ACTIVITY DATE G4. COMMENTS

H4. SOURCE LOCATION ADDRESS L4. SAME AS STREET

ADDRESS

I4. CITY J4. STATE K4. ZIP CODE

B5. SOURCE MODEL C5. SOURCE SERIAL

NUMBER

D5. ISOTOPE E5. ACTIVITY AND UNIT F5. ACTIVITY DATE G5. COMMENTS

H5. SOURCE LOCATION ADDRESS L5. SAME AS STREET

ADDRESS

I5. CITY J5. STATE K5. ZIP CODE

A6. SOURCE MAKE B6. SOURCE MODEL C6. SOURCE SERIAL

NUMBER

D6. ISOTOPE E6. ACTIVITY AND UNIT F6. ACTIVITY DATE G6. COMMENTS

H6. SOURCE LOCATION ADDRESS L6. SAME AS STREET

ADDRESS

I6. CITY J6. STATE K6. ZIP CODE

A5. SOURCE MAKE

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

6. SOURCE TRANSFER DATA

G1. SOURCE MAKE H1. SOURCE MODEL I1. SOURCE SERIAL

NUMBER

J1. ISOTOPE K1. ACTIVITY AND

UNIT

L1. ACTIVITY

DATE

P1. COMMENTS

M1. WASTE MANIFEST NO.

(For waste shipments only)

B1. RECEIVING LICENSEE C1. RECEIVING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A1. RECEIVING LICENSEE NAME

N1. CONTAINER ID 

(For waste shipments only)

O1. ESTIMATED ARRIVAL DATE

D1. CITY E1. STATE F1. ZIP CODE

G2. SOURCE MAKE H2. SOURCE MODEL I2. SOURCE SERIAL

NUMBER

J2. ISOTOPE K2. ACTIVITY AND

UNIT

L2. ACTIVITY

DATE

P2. COMMENTS

M2. WASTE MANIFEST NO.

(For waste shipments only)

B2. RECEIVING LICENSEE C2. RECEIVING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A2. RECEIVING LICENSEE NAME

N2. CONTAINER ID 

O2. ESTIMATED ARRIVAL DATE

D2. CITY E2. STATE F2. ZIP CODE

(For waste shipments 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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

6. SOURCE TRANSFER DATA (continued)

G3. SOURCE MAKE H3. SOURCE MODEL I3. SOURCE SERIAL

NUMBER

J3. ISOTOPE K3. ACTIVITY AND

UNIT

L3. ACTIVITY

DATE

P3. COMMENTS

M3. WASTE MANIFEST NO.

(For waste shipments only)

B3. RECEIVING LICENSEE C3. RECEIVING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A3. RECEIVING LICENSEE NAME

N3. CONTAINER ID 

(For waste shipments only)

O3. ESTIMATED ARRIVAL DATE

D3. CITY E3. STATE F3. ZIP CODE

G4. SOURCE MAKE H4. SOURCE MODEL I4. SOURCE SERIAL

NUMBER

J4. ISOTOPE K4. ACTIVITY AND

UNIT

L4. ACTIVITY

DATE

P4. COMMENTS

M4. WASTE MANIFEST NO.

(For waste shipments only)

B4. RECEIVING LICENSEE C4. RECEIVING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A4. RECEIVING LICENSEE NAME

N4. CONTAINER ID 

O4. ESTIMATED ARRIVAL DATE

D4. CITY E4. STATE F4. ZIP CODE

(For waste shipments 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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

7. SOURCE RECEIPT DATA

G1. SOURCE MAKE H1. SOURCE MODEL I1. SOURCE SERIAL

NUMBER

J1. ISOTOPE K1. ACTIVITY AND UNIT L1. ACTIVITY

DATE

T1. COMMENTS

M1. WASTE MANIFEST NO.

B1. SENDING LICENSEE C1. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A1. SENDING LICENSEE NAME

N1. CONTAINER ID 

O1. SOURCE LOCATION ADDRESS

D1. CITY E1. STATE F1. ZIP CODE

P1. CITY Q1. STATE R1. ZIP CODE S1. SAME AS STREET

ADDRESS

G2. SOURCE MAKE H2. SOURCE MODEL I2. SOURCE SERIAL

NUMBER

J2. ISOTOPE K2. ACTIVITY AND UNIT L2. ACTIVITY

DATE

T2. COMMENTS

M2. WASTE MANIFEST NO.

B2. SENDING LICENSEE C2. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A2. SENDING LICENSEE NAME

N2. CONTAINER ID 

O2. SOURCE LOCATION ADDRESS

D2. CITY E2. STATE F2. ZIP CODE

P2. CITY Q2. STATE R2. ZIP CODE S2. SAME AS STREET

ADDRESS

(For waste shipments only)

(For waste shipments only) (For waste shipments only)

(For waste shipments 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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

7. SOURCE RECEIPT DATA (continued)

G3. SOURCE MAKE H3. SOURCE MODEL I3. SOURCE SERIAL

NUMBER

J3. ISOTOPE K3. ACTIVITY AND UNIT L3. ACTIVITY

DATE

T3. COMMENTS

M3. WASTE MANIFEST NO.

B3. SENDING LICENSEE C3. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A3. SENDING LICENSEE NAME

N3. CONTAINER ID 

O3. SOURCE LOCATION ADDRESS

D3. CITY E3. STATE F3. ZIP CODE

P3. CITY Q3. STATE R3. ZIP CODE S3. SAME AS STREET

ADDRESS

G4. SOURCE MAKE H4. SOURCE MODEL I4. SOURCE SERIAL

NUMBER

J4. ISOTOPE K4. ACTIVITY AND UNIT L4. ACTIVITY

DATE

T4. COMMENTS

M4. WASTE MANIFEST NO.

B4. SENDING LICENSEE C4. SENDING LICENSEE SHIPPING ADDRESS

LICENSE NO.

A4. SENDING LICENSEE NAME

N4. CONTAINER ID 

O4. SOURCE LOCATION ADDRESS

D4. CITY E4. STATE F4. ZIP CODE

P4. CITY Q4. STATE R4. ZIP CODE S4. SAME AS STREET

ADDRESS

(For waste shipments only)

(For waste shipments only) (For waste shipments only)

(For waste shipments 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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

8. SOURCE DISPOSAL DATA

D1. SOURCE MAKE E1. SOURCE MODEL F1. SOURCE SERIAL

NUMBER

G1. ISOTOPE H1. ACTIVITY AND UNIT I1. ACTIVITY DATE J1. COMMENTS

A1. WASTE MANIFEST NUMBER B1. CONTAINER ID

K1. SOURCE DISPOSAL ADDRESS

C1. METHOD OF DISPOSAL

L1. CITY M1. STATE N1. ZIP CODE O1. SAME AS STREET

ADDRESS

D2. SOURCE MAKE E2. SOURCE MODEL F2. SOURCE SERIAL

NUMBER

G2. ISOTOPE H2. ACTIVITY AND UNIT I2. ACTIVITY DATE J2. COMMENTS

A2. WASTE MANIFEST NUMBER B2. CONTAINER ID

K2. SOURCE DISPOSAL ADDRESS

C2. METHOD OF DISPOSAL

L2. CITY M2. STATE N2. ZIP CODE

ADDRESS

O2. SAME AS STREET

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

8. SOURCE DISPOSAL DATA (continued)

D3. SOURCE MAKE E3. SOURCE MODEL F3. SOURCE SERIAL

NUMBER

G3. ISOTOPE H3. ACTIVITY AND UNIT I3. ACTIVITY DATE J3. COMMENTS

A3. WASTE MANIFEST NUMBER B3. CONTAINER ID

K3. SOURCE DISPOSAL ADDRESS

C3. METHOD OF DISPOSAL

L3. CITY M3. STATE N3. ZIP CODE O3. SAME AS STREET

ADDRESS

D4. SOURCE MAKE E4. SOURCE MODEL F4. SOURCE SERIAL

NUMBER

G4. ISOTOPE H4. ACTIVITY AND UNIT I4. ACTIVITY DATE J4. COMMENTS

A4. WASTE MANIFEST NUMBER B4. CONTAINER ID

K4. SOURCE DISPOSAL ADDRESS

C4. METHOD OF DISPOSAL

L4. CITY M4. STATE N4. ZIP CODE

ADDRESS

O4. SAME AS STREET

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

9. NEW MANUFACTURED SOURCE DATA

A1. SOURCE MAKE B1. SOURCE MODEL C1. SOURCE SERIAL

NUMBER

D1. ISOTOPE E1. ACTIVITY AND UNIT

G1. SOURCE LOCATION ADDRESS K1. SAME AS

STREET ADDRESS

F1. COMMENTS

H1. CITY I1. STATE J1. ZIP CODE

A2. SOURCE MAKE B2. SOURCE MODEL C2. SOURCE SERIAL

NUMBER

D2. ISOTOPE E2. ACTIVITY AND UNIT

G2. SOURCE LOCATION ADDRESS K2. SAME AS

STREET ADDRESS

F2. COMMENTS

H2. CITY I2. STATE J2. ZIP CODE

A3. SOURCE MAKE B3. SOURCE MODEL C3. SOURCE SERIAL

NUMBER

D3. ISOTOPE E3. ACTIVITY AND UNIT

G3. SOURCE LOCATION ADDRESS K3. SAME AS

STREET ADDRESS

F3. COMMENTS

H3. CITY I3. STATE J3. ZIP CODE

A4. SOURCE MAKE B4. SOURCE MODEL C4. SOURCE SERIAL

NUMBER

D4. ISOTOPE E4. ACTIVITY AND UNIT

G4. SOURCE LOCATION ADDRESS K4. SAME AS

STREET ADDRESS

F4. COMMENTS

H4. CITY I4. STATE J4. ZIP CODE

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

10. SOURCE IMPORT DATA

F1. SOURCE MAKE G1. SOURCE MODEL H1. SOURCE SERIAL

NUMBER

I1. ISOTOPE J1. ACTIVITY AND UNIT K1. ACTIVITY DATE L1. COMMENTS

A1. FOREIGN COMPANY NAME B1. IMPORT LICENSE NO. C1. FOREIGN COMPANY ADDRESS

M1. SOURCE LOCATION ADDRESS

D1. CITY E1. COUNTRY

N1. CITY O1. STATE P1. ZIP CODE Q1. SAME AS STREET

ADDRESS

F2. SOURCE MAKE G2. SOURCE MODEL H2. SOURCE SERIAL

NUMBER

I2. ISOTOPE J2. ACTIVITY AND UNIT K2. ACTIVITY DATE L2. COMMENTS

A2. FOREIGN COMPANY NAME B2. IMPORT LICENSE NO. C2. FOREIGN COMPANY ADDRESS

M2. SOURCE LOCATION ADDRESS

D2. CITY E2. COUNTRY

N2. CITY O2. STATE P2. ZIP CODE Q2. SAME AS STREET

ADDRESS

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

10. SOURCE IMPORT DATA (continued)

F3. SOURCE MAKE G3. SOURCE MODEL H3. SOURCE SERIAL

NUMBER

I3. ISOTOPE J3. ACTIVITY AND UNIT K3. ACTIVITY DATE L3. COMMENTS

A3. FOREIGN COMPANY NAME B3. IMPORT LICENSE NO. C3. FOREIGN COMPANY ADDRESS

M3. SOURCE LOCATION ADDRESS

D3. CITY E3. COUNTRY

N3. CITY O3. STATE P3. ZIP CODE Q3. SAME AS STREET

ADDRESS

F4. SOURCE MAKE G4. SOURCE MODEL H4. SOURCE SERIAL

NUMBER

I4. ISOTOPE J4. ACTIVITY AND UNIT K4. ACTIVITY DATE L4. COMMENTS

A4. FOREIGN COMPANY NAME B4. IMPORT LICENSE NO. C4. FOREIGN COMPANY ADDRESS

M4. SOURCE LOCATION ADDRESS

D4. CITY E4. COUNTRY

N4. CITY O4. STATE P4. ZIP CODE Q4. SAME AS STREET

ADDRESS

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

11. SOURCE EXPORT DATA

F1. SOURCE MAKE G1. SOURCE MODEL H1. SOURCE SERIAL

NUMBER

I1. ISOTOPE J1. ACTIVITY AND UNIT K1. ACTIVITY DATE L1. CONTAINER ID

A1. FOREIGN COMPANY NAME B1. EXPORT LICENSE NO. C1. ULTIMATE CONSIGNEE ADDRESS

M1. COMMENTS

D1. CITY E1. COUNTRY

F2. SOURCE MAKE G2. SOURCE MODEL H2. SOURCE SERIAL

NUMBER

I2. ISOTOPE J2. ACTIVITY AND UNIT K2. ACTIVITY DATE L2. CONTAINER ID

A2. FOREIGN COMPANY NAME B2. EXPORT LICENSE NO. C2. ULTIMATE CONSIGNEE ADDRESS

M2. COMMENTS

D2. CITY E2. COUNTRY

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

11. SOURCE EXPORT DATA (continued)

F3. SOURCE MAKE G3. SOURCE MODEL H3. SOURCE SERIAL

NUMBER

I3. ISOTOPE J3. ACTIVITY AND UNIT K3. ACTIVITY DATE L3. CONTAINER ID

A3. FOREIGN COMPANY NAME B3. EXPORT LICENSE NO. C3. ULTIMATE CONSIGNEE ADDRESS

M3. COMMENTS

D3. CITY E3. COUNTRY

F4. SOURCE MAKE G4. SOURCE MODEL H4. SOURCE SERIAL

NUMBER

I4. ISOTOPE J4. ACTIVITY AND UNIT K4. ACTIVITY DATE L4. CONTAINER ID

A4. FOREIGN COMPANY NAME B4. EXPORT LICENSE NO. C4. ULTIMATE CONSIGNEE ADDRESS

M4. COMMENTS

D4. CITY E4. COUNTRY

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

12. SOURCE DISASSEMBLE DATA

A1. SOURCE MAKE B1. SOURCE MODEL C1. SOURCE SERIAL

NUMBER

D1. ISOTOPE E1. ACTIVITY

I1. SOURCE LOCATION ADDRESS M1. SAME AS

STREET ADDRESS

H1. COMMENTS

J1. CITY K1. STATE L1. ZIP CODE

A2. SOURCE MAKE B2. SOURCE MODEL C2. SOURCE SERIAL

NUMBER

D2. ISOTOPE E2. ACTIVITY

AND UNIT

I2. SOURCE LOCATION ADDRESS M2. SAME AS

STREET ADDRESS

H2. COMMENTS

J2. CITY K2. STATE L2. ZIP CODE

A3. SOURCE MAKE B3. SOURCE MODEL C3. SOURCE SERIAL

NUMBER

D3. ISOTOPE E3. ACTIVITY

AND UNIT

I3. SOURCE LOCATION ADDRESS M3. SAME AS

STREET ADDRESS

H3. COMMENTS

J3. CITY K3. STATE L3. ZIP CODE

A4. SOURCE MAKE B4. SOURCE MODEL C4. SOURCE SERIAL

NUMBER

D4. ISOTOPE E4. ACTIVITY

AND UNIT

I4. SOURCE LOCATION ADDRESS M4. SAME AS

STREET ADDRESS

H4. COMMENTS

J4. CITY K4. STATE L4. ZIP CODE

G1. DISASSEMBLE

DATE

F1. ACTIVITY

DATE

G2. DISASSEMBLE

DATE

F2. ACTIVITY

DATE

G3. DISASSEMBLE

DATE

F3. ACTIVITY

DATE

G4. DISASSEMBLE

DATE

F4. ACTIVITY

DATE

AND UNIT

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.
NRC FORM 748

(05-22-2023)

10 CFR 20.2207 NATIONAL SOURCE TRACKING

TRANSACTION REPORT (continued)

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 748 (05-22-2023)

LICENSEE NAME LICENSE NO.

12. SOURCE DISASSEMBLE DATA (continued)

A5. SOURCE MAKE B5. SOURCE MODEL C5. SOURCE SERIAL

NUMBER

D5. ISOTOPE E5. ACTIVITY

I5. SOURCE LOCATION ADDRESS M5. SAME AS

STREET ADDRESS

H5. COMMENTS

J5. CITY K5. STATE L5. ZIP CODE

A6. SOURCE MAKE B6. SOURCE MODEL C6. SOURCE SERIAL

NUMBER

D6. ISOTOPE E6. ACTIVITY

AND UNIT

I6. SOURCE LOCATION ADDRESS M6. SAME AS

STREET ADDRESS

H6. COMMENTS

J6. CITY K6. STATE L6. ZIP CODE

A7. SOURCE MAKE B7. SOURCE MODEL C7. SOURCE SERIAL

NUMBER

D7. ISOTOPE E7. ACTIVITY

AND UNIT

I7. SOURCE LOCATION ADDRESS M7. SAME AS

STREET ADDRESS

H7. COMMENTS

J7. CITY K7. STATE L7. ZIP CODE

A8. SOURCE MAKE B8. SOURCE MODEL C8. SOURCE SERIAL

NUMBER

D8. ISOTOPE E8. ACTIVITY

AND UNIT

I8. SOURCE LOCATION ADDRESS M8. SAME AS

STREET ADDRESS

H8. COMMENTS

J8. CITY K8. STATE L8. ZIP CODE

G5. DISASSEMBLE

DATE

F5. ACTIVITY

DATE

G6. DISASSEMBLE

DATE

F6. ACTIVITY

DATE

G7. DISASSEMBLE

DATE

F7. ACTIVITY

DATE

G8. DISASSEMBLE

DATE

F8. ACTIVITY

DATE

AND UNIT

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.
INSTRUCTIONS TO NRC AND AGREEMENT STATE LICENSEES FOR REPORTING HIGH-RISK SEALED SOURCE TRANSACTIONS 

The completed form is considered to be Official Use Only – Security Related Information; it is not considered to be Safeguards Information. 

Use an addendum sheet for reporting additional sources.

Note to Licensees: This form may be used to report source transactions in lieu of 

using the NSTS online application. Sections 1-4 on Page 1 of the form are required 

for all source transaction types. Sections 5-12 should only be populated for the 

associated Transaction Type (3B) selected. For example, when reporting a Source 

Transfer and a Source Export, Sections 6 and 11 should be populated. Multiple 

Transaction Types may be selected if they occur on the same Transaction Date, and 

should be reported on NRC Form 748. Licensees reporting only one transaction type 

may use the condensed form for the Transaction Type. For example, when reporting 

a Source Receipt, NRC Form 748c should be used. 

1. Licensee Information – Enter the name, license number, and street address of 

the licensed facility. 

2. Transaction Date – Enter the date the transaction occurred, which would be the date 

of the transfer, receipt, manufacture, etc. 

3. Transaction Information and Transaction Type – Indicate if this is a new transaction

or a correction. For corrections, select the date of the previously submitted 

transaction that the correction should be associated with. Select the Transaction 

Type. Report Source should only be used for initial inventory submissions, or to 

report a source excluded from the initial inventory submission. Dispose Source 

should only be used by a Disposal Licensee. If you are sending your source back to 

the manufacturer, or sending it to a disposal facility, the transaction should be 

recorded as a Transfer. Multiple Transaction Types may be selected if they occur on 

the same Transaction Date. 

4. Preparer Information – An email address is required for a confirmation. For

regulatory purposes, your source transaction report is not considered complete 

without a confirmation from the NSTS Help Desk that the transaction report has 

been received. 

5. Source Inventory Data – This section should only be used for initial inventory 

submissions. The Make, Model, and Serial Number refer to the Source, not the 

Device. All fields are required in Section 5 EXCEPT G. Comments. If the licensee is 

reporting multiple sources on the Source Inventory transaction at the same Source 

Location Address, the location address information may be populated once, and 

referenced in the Comments block for the additional sources. 

6. Source Transfer Data – For Transfer transaction reports, all fields in Section 6 are 

required EXCEPT M. Waste Manifest Number, N. Container ID, and P. Comments. If 

the licensee is reporting multiple sources on the Transfer transaction to the same 

Receiving Licensee, the receiving licensee information may be populated once, and 

referenced in the Comments block for the additional sources. 

7. Source Receipt Data – For Receipt transaction reports, all fields in Section 7 are 

required EXCEPT M. Waste Manifest Number, N. Container ID, and T. Comments. If 

the licensee is reporting multiple sources on the Receipt transaction at the same 

Source Location Address, the location address information may be populated once, 

and referenced in the Comments block for the additional sources. 

8. Source Disposal Data – For Disposal transaction reports, all fields in Section 8 are 

required EXCEPT J. Comments. If the licensee is reporting multiple sources on the 

Disposal transaction at the same Source Disposal Address, the source disposal 

address information may be populated once, and referenced in the Comments block 

for the additional sources. 

9. New Manufactured Source Data – For New Manufactured Source transaction 

reports, all fields in Section 9 are required EXCEPT F. Comments. If the licensee is 

reporting multiple sources on the Manufacturer transaction at the same Source 

Location Address, the location address information may be populated once, and 

referenced in the Comments block for the additional sources. 

10. Source Import Data – For Import Source transaction reports, all fields are required 

EXCEPT L. Comments. If the licensee is reporting multiple sources on the Import 

transaction at the same Source Location Address, the location address information 

may be populated once, and referenced in the Comments block for the additional 

sources. 

11. Source Export Data – For Export Source transaction reports, all fields are required 

EXCEPT M. Comments. If the licensee is reporting multiple sources on the Export 

transaction to the same Foreign Company/Foreign Address, the information in cells 

A-E may be populated once, and referenced in the Comments block for the 

additional sources. 

12. Source Disassemble Data – For Disassemble Source transaction reports, all fields 

are required EXCEPT H. Comments. If the licensee is reporting multiple sources on 

the Disassemble transaction at the same Source Location Address, the location 

address information may be populated once, and referenced in the Comments block 

for the additional sources. 

DISTRIBUTION

For most timely processing, click the "Submit by Email" button on page 1. 

You may also: 

 > manually submit this form by email to: NSTSFax.Resource@nrc.gov, 

 > FAX to: 1-888-821-2534, or 

 > mail to: NSTS Help Desk 

 9737 Washingtonian Blvd, Room #3145, Mail Stop #9 

 Gaithersburg, MD 20878