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RC Form 540 U.S.Nuclear Regulatory Commission 5.SHIPPER-NAME AND FACILITY SHIPPER ID NUMBER 7.FORM 540 AND 540A PAGE 1 OF 1 PAGE(S) x.MANIFEST NUMBER <br /> SCM Safety FORM541 AND 541A I PAGE(S) T20286 <br /> FORM 542 AND 542A 1 PAGE(S) <br /> UNIFORM LOW-LEVEL RADIOACTIVE CIO American MasterTech ADDITIONAL INFORMATION 0PAGE(S) <br /> WASTE MANIFEST 1330 Thurman St ❑COLLECTOR TOTAL 3 PAGE(S) <br /> Lodi,CA 95240 ❑PROCESSOR I.CONSIGNEE-Name and Facility Address CONTACT <br /> Shipping Paper Environmental Mgmt.&Controls,Inc. Steven May <br /> .SER PERMIT NUMBER SHIPMENT NUMBER O <br /> GENERATORI Turlock,CA 95380 NUMBER TYPE 3106 S.Faith Home Rd. <br /> 'ELEPHONE <br /> 1.EMERGENCY TELEPHONE NUMBER(Include Area Cade) (209)667-1102 <br /> (714)745-5211 CONTACT TELEPHONE NUMBER <br /> ORGANIZATION Earl Thomas (925)362-2265x109 <br /> Thomas Gray&Associates,Inc. CARRIER-NAME AND ADDRESS EPAID NUMBER IGNATURE ATE <br /> 2.Is this an Exclusive Use Shipment?3.Total number of 2 Drum(s) Thomas Gray&Associates,Inc. CAD 066 151 648 <br /> CD8 e3 identified 1205 West Barkley Ave. 10.CERTIFICATION This is to certify that the herein-named materials are properly classed,described,packaged,marked,and <br /> Yes❑No g 'HIPPING DATE abeled and are in proper condition for transportation according to the applicable regulations of the Department of Transportation. <br /> on this manifest. g <br /> Oran e,CA 92868 07/17/2020 kis also certifies tbat de materials are proper condition marked,and labeled and are in propcondition for transportation and disposal as <br /> scribed in accordance with the applicable requirements of 10 CFR Pans 20 and 61,or equivalent state regulations. <br /> 4.DOES EPA REGULATED WASTE EPA MANIFEST NUMBER CONTACT TELEPHONE NUMBER <br /> REQUIRING A MANIFEST ACCOMPANY Richard Gallego (714)997-8090 <br /> THIS SHIPMENT?If"Yes"provide Manifest SIGNATURE-Authorized carrier acknowledging waste receipt DATE AUTHORIZED SIGNATURE TITLE TATE <br /> Nuns- Yes❑No <br /> U. 16.TOTALPACKAGE 17. l9. <br /> 11.U.S.DEPARTMENT OF TRANSPORTATION DESCRIPTION l2 DOT LABEL TRANSPORT 14 PHYSICAL AND CHEMICAL FORM 15.INDIVIDUAL RADIONUCLIDES ACrtyrty ]d TOTAL W EIGHT IDENTIFICATION <br /> "RADIOACTIVE" INDEX (•o bridged per 49 CFR§173.433(g)) MBq tap LCAISO OR VOLUME NUMBER OF <br /> PACKAGE <br /> UN2910,Radioactive material,excepted package-limited quantity of material,7 NA NA Ligtud/0.01%uranyl nitrate in water U-Nat 7.4E-7 (2.000E-8) NA 4.6 kg T20286-DO1 <br /> (10 lbs) <br /> UN2910,Radioactive material,excepted package-limited quantity of material,7 NA NA Liquid/0.01%uranyl nitrate in water U-Nat 7.4E-7 (2.000E-8) NA 4.6 kg T20286-DO2 <br /> (10 lbs) <br /> FOR CONSIGNEE USE ONLY IIuI�Illllllll�IIIIIIAh IIIIIIIII <br /> Email:ethomas@scm-safety.com Disposal Site(s):ES Clive II lu <br />