Importation Form | TLLRWDCC

ANNEX A

TLLRWDCC §675.23—IMPORTATION FORM

TEXAS LOW-LEVEL RADIOACTIVE WASTE DISPOSAL COMPACT COMMISSION APPLICATION
FOR IMPORTATION OF NON-PARTY LOW-LEVEL RADIOACTIVE WASTE (NOTE: PURSUANT TO
TEXAS HEALTH AND SAFETY CODE, §401.207(j), THIS PETITION MUST BE COMPLETED BY
APPROPRIATE REPRESENTATIVES OF THE DEPARTMENT OF DEFENSE OR THE GENERATOR OF
THE WASTE UNLESS THE GENERATOR IS A SMALL QUANTITY GENERATOR AS DEFINED IN 31
TAC §675.20(19), IN WHICH CASE THE PETITION MAY BE SUBMITTED BY AN APPROPRIATELY
LICENSED BROKER) (Article III, Sec. 3.05(7) of the Compact)

I. Applicant Information:

Entity Name *

Contact Person *

First

Last

Email *

Phone *

Website / URL

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Applicant is *

Did you self generate waste? *

Yes
No

What process generated the waste and how much? *

II. Generator Specifications

Generator Type *

Is waste from a "small quantity generator"? *

III. Agreement Period

Multiple Choice *

This Fiscal Year
Next Fiscal Year

Current fiscal year is Sept 1 to Aug 31 of the following year.

IV. Waste Proposed for Importation

Waste Volume (Cubic Feet) *

Waste Radioactivity (Curies) *

Waste Classification *

Class A
Class B
Class C

Waste Form *

Stable
Unstable

Does the proposed waste consist solely of sealed sources? *

Compact and/or unaffiliated state, territory, possession, or district of the United States where the waste was generated (please list) *

Current Location Of Waste *

Waste Description *

V. Compliance

Does Applicant have any unresolved violation(s), complaint(s), unpaid fee(s), or past due report(s) with the Texas Low-Level Radioactive Waste Disposal Compact Committee? *

No.
Yes. Please explain and attach applicable documents below.

Applicable Documents #1

Does Applicant have any unresolved violation(s), complaint(s), unpaid fee(s), or past due reports associated with radioactive waste receipt, storage, handling, management, processing, or transportation pending with any other regulatory agency with jurisdiction to regulate radioactive material including, without limitation, the Texas Commission on Environmental Quality (TCEQ)? *

No.
Yes. Please explain and attach applicable documents below.

Applicable Documents #2

VI. Certifications

Applicant hereby certifies* the following:

The information provided herein is complete, accurate, and correct.
The waste proposed for importation is not waste of international origin.
The low-level radioactive waste for which this Import Application is submitted will be packaged and shipped in accordance with applicable state and federal regulations and is acceptable for disposal at the Compact Facility.
The person submitting this Import Application is authorized by the Applicant to commit Applicant to each and every obligation and condition set forth herein and in the Agreement for Importation of Non-Party Compact Waste. A copy of a written document containing such authorization must be attached to this Import Application.
Applicant has delivered to the specified disposal facility and TCEQ a copy of this Application for Importation of Compact Waste (along with any supplement or amendment thereto).

* If any box is left unchecked, the Commission will assume that requirement was not met.

VII. Authorized Signatory

Name *

First

Last

Title *

Date *

VIII. Attachments/Comments

Other Comments