South Carolina Code of Regulations › Chapter 61 - DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL › Subchapter 61-83 - Transportation of Radioactive Waste Into or Within South Carolina › Attachment III - Form RHA-CT "Radioactive Waste Shipment Certification Form"

Current through Register Vol. 48, No. 6, June 28, 2024
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL
				CONTROL
Radioactive Waste Shipment Certification Form
General Instructions and Information: This is a two part form
				to be used by
shippers and carriers of radioactive waste. The certifications
				contained
herein satisfy the requirements of Section
				13-7-150,
				of Act No. 429 of 1980,
the South Carolina Radioactive Waste Transportation and
				Disposal Act. This
certification along with a copy of the prior notification form
				shall
accompany each shipment of radioactive waste into and within
				the State of
South Carolina. The shipper is to complete his portion of the
				form and
present it to the carrier as part of the shipping documents.
				Upon receipt,
the carrier shall complete his portion of the form. Upon
				delivery of the
shipment to the consignee, a copy of this certification form,
				and a copy of
the Prior Notification and Manifest form with the consignee
				acknowledgement,
shall be returned to the Department.
-------------------------------------------------------------------------------
Part I: Shipper's Certificate of Compliance
-------------------------------------------------------------------------------
1. Name of Shipper and Address: :
2. Shipment Identification No.
:
: -------------------------------------:
3. Transport Permit No.
Telephone No. ( ) :
-------------------------------------------------------------------------------
In compliance with Act No. 429 of 1980, the South Carolina
				Radioactive Waste
Transportation and Disposal Act, I hereby certify on behalf of
				the
above-named shipper to the South Carolina Department of Health
				and
Environmental Control that the above-named shipper has complied
				with all
provisions of Act No. 429 of 1980, and all applicable laws and
				administrative
rules and regulations, both State and Federal, regarding the
				packaging,
transportation, storage, disposal and delivery of such wastes.
				I further
certify that this shipment of radioactive waste has been
				inspected within 48
hours of the time of departure and that no items of
				non-compliance with
applicable laws, rules or regulations were found.
Date ________________________________
_____________________________________
				_____________________________________
Typed Name and Title of Agent of Signature
Shipper
-------------------------------------------------------------------------------
Part II: Carrier's Certification
-------------------------------------------------------------------------------
1. Name of Carrier and Address: :
2. Shipment Identification No.
:
: -------------------------------------
:
3.
			 Transport Trailer No.
Telephone No. ( ) :
-------------------------------------------------------------------------------
4. Scheduled Date of Departure of :
5.  Estimated Date of Arrival of
Shipment: : Shipment:
-------------------------------------------------------------------------------
Certification is hereby made to the South Carolina Department
				of Health and Environmental Control that:
(a) the shipper has provided the carrier with
			 a
copy of the shipment manifest, the certificate of compliance,
				and the routing instructions;
(b) the shipment of radioactive waste has
			 been properly placarded for transport according to applicable U.S. Department
			 of Transportation Regulations;
(c)
			 all shipping papers originated or reproduced by the carrier have been properly
			 executed;
(d) the transport vehicle
			 has been inspected according to applicable State and Federal regulations within
			 the prescribed intervals and that all safety and operational components are in
			 good working order and meet the requirements of regulations;
(e) all drivers who will operate the vehicle
			 within the State of South Carolina are qualified to transport hazardous
			 materials as specified by applicable U.S. Department of Transportation
			 regulations;
(f) the Department
			 shall be immediately notified of any variance, occurring after departure, from
			 the shipper's notification of primary routes in South Carolina and estimated
			 date of arrival;
(g) all applicable
			 laws and administrative rules and regulations, both State and Federal,
			 regarding the transportation of radioactive wastes
will be complied with.
Date_________________________________
%
W
4
0
_____________________________________
				_____________________________________
Typed or Printed Name and Title Signature
DHEC 803
(5/80) (Copies of this form may be reproduced locally as
				needed)