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 II - Form RHA-PNC "Radioactive Waste Shipment Prior Notification and Manifest Form"

Current through Register Vol. 48, No. 6, June 28, 2024
Form RHA-PHC
(5/80) SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL
				CONTROL
Radioactive Waste Shipment Prior Notification and Manifest
				Form
-------------------------------------------------------------------------------
See Reverse Side for Instructions
-------------------------------------------------------------------------------
1. Name and Address of Shipper: :
2. Person Responsible for Radioactive
: Waste Shipment:
: (a) Name
: (b) Title
: (c) Telephone No. ( )
-------------------------------------------------------------------------------
3. Radioactive Waste Transport
			 :
4. Shipment Identification No.:
Permit No. :
:
:
-------------------------------------------------------------------------------
5. Location from which waste :
6. Name and Address of Consignee
			 will be shipped: :
:
:
:
-------------------------------------------------------------------------------
7. Scheduled Date of Departure :
8. Estimated Date of Arrival of of
			 Shipment: : Shipment:
:
:
-------------------------------------------------------------------------------
9. Carrier: :
10. Type of Transport :
11. Trailer No. and Owner
: Vehicle: : (if available)
: :
-------------------------------------------------------------------------------
12. Routes shipment will follow in
			 State of South Carolina (Be Specific):
-------------------------------------------------------------------------------
Manifest Summary
-------------------------------------------------------------------------------
13. Type Container :
14. Container Spec. :
15. Total No. of
or Cask: : : Containers
: :
: :
-------------------------------------------------------------------------------
16. Waste Description: Physical
			 and Chemical :
17. Prominent
Form : Radionuclides:
:
:
-------------------------------------------------------------------------------
18. Total Curies: :
19. Transport Group: :
20. Total Cubic Feet:
: :
: :
-------------------------------------------------------------------------------
21. Waste Classification:
[ ] Radioactive [ ] Bulk LSA Normal Special Fissile
LSA Form Form
[ ] Radioactive [ ] Limited [ ] Type A [ ] Type A [ ] Class
				I
LSA quantities quantity quantity
greater and radio- [ ] Type B [ ] Type B [ ] Class II
than active quantity quantity
Type A devices [ ] Large [ ] Large [ ] Class III
quantities quantity quantity
-------------------------------------------------------------------------------
CERTIFICATION
-------------------------------------------------------------------------------
I hereby certify on behalf of the above-named shipper to the
				South Carolina
Department of Health and Environmental Control that the
				information provided
herein is complete and correct to the best of my knowledge; and
				that the
shipper has complied with all the provisions as required by Act
				No. 429 of
1980, the South Carolina Radioactive Waste Transportation and
				Disposal Act.
Date _________________________________
______________________________________
				_______________________________________
Typed Name and Title of Agent of Signature
Shipper
-------------------------------------------------------------------------------
CONSIGNEE ACKNOWLEDGEMENT
-------------------------------------------------------------------------------
This acknowledges to the South Carolina Department of Health
				and
Environmental Control that the above-described radioactive
				waste
shipment was received.
__________________________________
				____________________________________
Date of Delivery Signature of Consignee or authorized
Agent
____________________________________
Typed or Printed Name and Title
DHEC 802 ( 5/80 )
(Copies of this form may be reproduced locally as
				needed)