APPROVED BY OMB: NO. 3150-0164 Estimated burden per response to comply with this information collection request: 45 minutes. 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 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, (3150-0164), 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 540 U.S. NUCLEAR REGULATORY COMMISSION

UNIFORM LOW-LEVEL RADIOACTIVE 

WASTE MANIFEST SHIPPING PAPER 

See NUREG/BR-0204 for detailed instructions for completing this form: 

http://www.nrc.gov/reading-rm/doc-collections/nuregs/brochures/br0204/

1. Emergency Telephone Number (Include area code) 

Organization

 Yes No

2. Is this an "Exclusive Use" 

 Shipment?

 Yes No

5. Shipper - Name and Facility

User Permit Number Shipment Number

Contact

6. Carrier - Name and Address

Contact

Signature - Authorized carrier acknowledging waste receipt

Shipper ID Number

 Collector Processor

 Generator Type (Specify)

Phone No (Include Area Code)

EPA I.D. Number

Shipping Date

Date

Phone No (Include Area Code)

7. NRC Form 540 and 540A Page 1 of

NRC Form 541 and 541A

NRC Form 542 and 542A

Additional Information Contact

Page(s)

Page(s)

Page(s)

Page(s)

Electronic 8. Manifest Number

Phone No (Include Area Code)

Date

9. Consignee - Name and Facility Address

Signature - Authorized consignee acknowledging waste receipt

10. CERTIFICATION

“This is to certify that the herein-named materials are properly classified, described, packaged, marked, and labeled and are in 

proper condition for transportation according to the applicable regulations of the Department of Transportation, the Commission, 

and equivalent state regulations. For materials that are consigned to a land disposal facility or waste collector, this certifies that 

the materials are classified per the applicable requirements of 10 CFR Part 61, meet the land disposal facility's waste acceptance 

criteria, and are in proper condition for disposal as described in accordance with the applicable requirements of 10 CFR Parts 20 

and 61, or equivalent state regulations. A collector in signing the certification is certifying that nothing has been done to the 

collected waste which would invalidate the waste generator's certification.”

Authorized Signature and Title Date

11. U. S. Department of Transportation Description 

(Including UN ID number, proper shipping name, 

hazard class, and any additional information)

12. DOT Labels 13. Transport 

 Index

14. Physical and 

Chemical Form 15. Individual Radionuclides 16. Maximum Package Activity in SI Units

17. Total Weight 

or Volume 

(Use appropriate units)

18. Identification 

 Number of 

Package

For Consignee Use Only

NRC FORM 540 (04-26-2023)

3. Total Number of packages identified

 on this manifest?

4. Does EPA regulated waste requiring a 

 manifest accompany this shipment? 

 (If "Yes," provide Manifest Number).

EPA Manifest Number