Wyoming Administrative Code › Agency 045 - Transportation, Dept. of › Sub-Agency 0004 - Motor Carrier › Chapter 2 - RADIOACTIVE WASTE TRANSPORTATION BY MOTOR CARRIER › Section 2-7 - Permit and Application Forms

Current through July 13, 2024
The application and permit forms shall be generally as set
				  forth in the following:
WYOMING DEPARTMENT OF TRANSPORTATION
Radioactive Waste Transportation Permit Application
				  Form
for a
PERMANENT PERMIT
TEMPORARY PERMIT (for only one trip as described in the
				  following)
1.
				  ___________________________________________________________________
Name of carrier
2.
				  ___________________________________________________________________
Address and regular business telephone number of
				  carrier
3.
				  ___________________________________________________________________
Contact person and 24-hour emergency telephone number that
				  will always be answered
4. General description of radioactive waste intended for
				  transport, including type of material, estimated number of shipments and
				  packages, description of packages, and estimated radioactivity per shipment
				  (precise information not necessary if unavailable):
_____________________________________________________________________
_____________________________________________________________________
5. Description of mode of transportation, route or routes to
				  be taken, and approximate schedule (precise information not necessary if
				  unavailable):
_____________________________________________________________________
_____________________________________________________________________
6. Describe any violations by applicant of local, state, or
				  federal regulations in the past year relating to radioactive waste
				  transportation. (If none, so state. Completing this section is voluntary except
				  in the case of an accident resulting in the release of radioactivity.):
_____________________________________________________________________
_____________________________________________________________________
7. Other information that might be helpful in case of an
				  accident involving radioactive waste (Completing this section is voluntary.):
_____________________________________________________________________
_____________________________________________________________________
READ CAREFULLY BEFORE SIGNING
I
				  hereby certify that the information given to obtain the requested permit is
				  true and correct. I hereby certify that the carrier has a 24-hour telephone
				  number for all persons for whom the carrier is transporting radioactive waste
				  under the permit. The carrier agrees to pay all emergency response fees (at the
				  rate of $200 per package transported) to become due under the rules and
				  reporting requirements of the Wyoming Department of Transportation, Accounting
				  Program, 5300 Bishop Blvd., Cheyenne, Wyoming 82009. The carrier agrees to obey
				  all placarding and safety requirements for transporting radioactive waste as
				  set forth in Title 49 of the Code of Federal Regulations (C.F.R.). I understand
				  that, if this application is for a permanent permit, I may transport
				  radioactive waste within and through Wyoming for 30 days after the application
				  date set forth in the following without a permit, that I shall pay all
				  applicable emergency response fees associated with such transportation, and
				  that I shall obey all applicable radioactive waste transportation safety
				  regulations during this time. I understand the shipper's duty to provide
				  supplemental information under the rules of the Wyoming Department of
				  Transportation. I understand that, if this application is for a temporary
				  permit, I may elect to pay my emergency response fees at the time the permit is
				  granted or to pay quarterly as billed to me by the Wyoming Department of
				  Transportation, Accounting Program, 5300 Bishop Blvd., Cheyenne, Wyoming 82009.
				  Based on the foregoing, I hereby apply for a permanent/temporary (circle one)
				  permit to transport radioactive waste within and through Wyoming.
Carrier
Name:
				  _______________________________________________________________
By: _____________________________________________ Date
				  _______________
Signature of Authorized Representative
Wyoming DOT Docket No. M- ____________________ Permit No.
				  _______________
PERMIT TO TRANSPORT RADIOACTIVE WASTE
(Issued pursuant to
				  W.S.
				  37-14-103 )
Granted to the preceding carrier, for radioactive waste
				  transportation as described in this application, on _______________ , ____, at
				  ________ am pm (circle one) by ______________________ at ___________________ ,
				  Wyoming. (Station and clerk number [for temporary permit] if applicable:
				  ___________________________ .)
___________________________________
SIGNATURE OF ISSUING AUTHORITY
SHIPPER PLEASE NOTE: This is one of two documents that shall
				  be carried to transport radioactive waste within or through Wyoming. Both the
Emergency Response Fee Report
for the load being transported
				  and a copy of the
Permit to Transport Radioactive Waste
shall
				  be carried with the load being transported.
Wyo DOT Form RWT-1 (10-91) Motor Carrier