North CarolinaLow-Level Radioactive Waste Survey

Calendar Year 2008

Part One: General Information

Licensee
Radiation Safety Officer
Street Address
City / State / Zip Code / //
E-Mail Address
Radioactive Materials License Number
Person Completing Survey / Title / /
Email address / Fax / /
Signature / Telephone / /
Date of Survey Completion

YES

/ NO
In 2008, did you generate any long-lived* radioactive waste?
In 2008, did you transfer any licensed material for disposal at a licensed low-level radioactive waste disposal facility?
Doyounow have any long-lived* radioactive waste in storage awaiting disposal?

* Long lived = radioactive material with half-life 165 days

If you answered YES to any of the above questions, complete Part Two. If you answered NO to all questions, STOP HERE and return this form.

Return Address:Wendy B. Tingle

North Carolina Radiation Protection

3825 Barrett Drive

Raleigh, NC27609

Fax Number:(919) 571-4148

Please return this survey by March 1, 2009 by mail or fax

Part Two: Waste Disposal, Management and Storage Information

Shipments

Report radioactive material and low-level radioactive waste (LLRW) shipments from January 1, 2008 through December 31, 2008.

Disposal Facility/BrokerClass AClass BCTotal

______Volume (ft3)______

Activity (mCi)______

Report mixed wasteshipped from January 1, 2008 through December 31, 2008.

Disposal Facility/BrokerClass AClass BCTotal

______Volume (ft3) ______

Activity (mCi)______

Report sealed sources shipped from January 1, 2008through December 31, 2008.

Manufacturer/Broker

______Isotope______Activity______

On-Site Management

Report any LLRW, including mixed waste that was processed/treated/disposed other than at a LLRW disposal facility.

MethodVolume (ft3)Activity (mCi)

Incineration______

Land Application______

Sanitary Sewer______

Storage

Report LLRW in storageas of December 31, 2008.

Class AClass B & CMixed WasteSealed SourcesBiological

Volume (ft3)______

Activity (mCi)______

How much on-site square footage do you utilize for LLRW storage?______ft2

Does your facility have near term plans for decommissioning or other activities that could increase LLRW production?______

Do you have LLRW or sealed sources that have been in storage for over two years?______

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