Form Rpd-37 - Norm Waste Manifest - Louisiana Department Of Environmental Quality (Page 2 of 2) in pdf

The Louisiana Department of Environmental Quality requires proper completion of all information on a manifest. All generators are responsible under the

Louisiana Radiation Regulations for the proper identification, manifesting, and ultimate disposal of all NORM they generate.

The NORM Waste Manifest consists of six copies:

Copy 1

Designated Facility to Louisiana Department of Environmental Quality

Copy 2

Designated Facility to Generator (does not include Shipper)

Copy 3

Designated Facility Retains

Copy 4

Transporter 2

Copy 5

Transporter 1

Copy 6

Generator or Shipper (decontamination or treatment facility)

Note: if NORM is manifested (manifest #1) to a decon/treatment facility, Copy 1 of manifest #1 should be retained until the NORM is remanifested back-out

(manifest #2) of the facility (Shipper). Shipper should attach Copy 1 of manifest #1 to Copy 1 of manifest #2 and sent to the Louisiana Department of

Environmental Quality.

Enter the total number of pages used to complete this manifest, the first page (RPD-37) plus the number.

Item 1

Enter the NORM facility seven digit ID# (DNR 6 digit well serial# or DEQ internal generated #),

Item 2

(NORM is to be tracked facility specific).

Enter either the generator or the shipper company name and mailing address.

Item 3

Generator e.g. XYZ Oil & Gas Company

Shipper e.g. XYZ Decon/Treatment Facility

Provide phone number where an authorized agent of your firm may be reached in the event

Items 4, 7,

of an emergency.

10,13, 16

Enter the generator’s DEQ 9 digit general license # (LA-operator code-N01) or the shipper’s DEQ 9

Item 5

digit specific license # (LA-DEQ Internal #-S01).

Enter the company name, and 6 digit ICC/USDOT/MC # of the first transporter.

Items 6 & 8

Enter the company name and 6 digit ICC/USDOT/MC # of the second transporter.

Items 9 & 11

Enter the company name and mailing address and the DEQ 9 digit specific license #.

Items 12 & 14

If generator has approval from the Louisiana Department of Environmental Quality (e.g. NORM waste

Item 15

management plan) to relocate NORM waste, or contaminated equipment to another location other than a

commercial licensed facility, enter the facility name, location, and phone number.

Enter the description of NORM.

Item 17

Enter the exposure radiation reading (microroentgen per hour) taken on the described NORM.

Item 18

Enter the activity concentration (if available) of the described NORM.

Item 19

Enter the number of NORM containers to be transported.

Item 20

Enter type of container derived from Table 1.

Item 21

Table 1

DM-

Metal drums, barrels, kegs

DF-

Fiberboard or plastic drums, barrels, kegs

TT-

Cargo Tanks (tank trucks)

DT-

Dump Truck

CM-

Metal boxes, cartons, cases (including rolloffs)

BA-

Burlap, cloth, paper or plastic bags

PT-

Production pipe, tubulars

DW-

Wooden drums, barrels, kegs

TP-

Tanks portable

TC-

Tank cars

CY-

Cylinders

CW-

Wooden boxes, cartons, cases

CF-

Fiber or plastic boxes, cartons, cases

PE-

Production equipment (i.e., heater treater, desalter)

Enter the total quantity (volume) of NORM described on each line.

Item 22

Enter the appropriate abbreviation for the unit of measure indicated below:

Item 23

G-gallons (liquid only)

P-pounds T-tons (2000 lbs)

Y- cubic yards

Generators should use this space to indicate special transportation,

treatment, storage, or disposal

Item 24

information or bill of lading information

The generator must read, sign (by hand), and date the certification

statement, or the shipper must sign

Item 25

and date to confirm that containerized NORM waste departed from his facility.

Enter the name of the person accepting the NORM on behalf of the first transporter. That person must

Item 26

acknowledge acceptance of the NORM described on the manifest by signing and entering the date of

receipt.

Enter, if applicable, the name of the person accepting the waste on behalf of the second transporter.

Item 27

That person must acknowledge acceptance of NORM described on the manifest by signing and entering

the date of receipt.

Enter the name of the person accepting the waste on behalf of the owner/operator of the designated

Item 28

facility. The date is the date of signature and receipt of shipment.

Mailing:

Louisiana Department of Environmental Quality

Emergency and Radiological Services Division

P. O. Box 4312

Baton Rouge, LA 70821-4312

Form Rpd-37 - Norm Waste Manifest - Louisiana Department Of Environmental Quality Page 2

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