Form68: Application to Recycle DOE Precious Metals and Scrap

DOE Business Center for Precious Metals Sales and Recovery


Form 68: Application to Recycle DOE Precious Metals and Scrap

Instructions:
• Use this form to obtain shipping instructions for recycling DOE-owned precious metals.
• Group scrap with identical characteristics, such as identical precious metals, alloys or foreign matter (e.g., graphites, stainless steel, toxic coatings, etc.). List dissimilar scrap on a separate form.

Business Center Lot No.:

Control No.:

Precious Metals Manager
(Signature):

DECLARATION OF SUBCONTRACTORS
DOE Contract No.: Name/Address of Contractor:	Contact Person: Telephone No.: Fax No.: Customer Email: Date of Application:

* DESCRIPTION OF SCRAP *

Precious Metals Content:
A. Metal Type	B. Grams of Precious Metals	C. Alloys (Y/N)	D. % of Alloys	E. Physical Form & Shape

* DESCRIPTION OF SCRAP *
F. Net Weight of Scrap in grams and detailed description of form:

RADIOACTIVITY
G. Known or suspected, alloys, impurities, and foreign matter (nonradioactive)
H. Do any of the items above contain any Hazardous Material? If so, please provide detail description. Yes No

Business Center does not accept radioactive contaminated metal or metal contaminated with radioactive material.
* Please be aware that the release limits for uranium and beta-gamma category radionnuclides are 2400 instead of 5000 dpm/100 cm2. *
I. Does the metal meet radiological release criteria? Yes No
J. Was the metal determined to be scrap while managed in a 10 CFR 835 defined Radiological area? Yes No

K. All metal that is returned to the Business Center is required to be monitored or process knowledge statement must be provide below in section L. Was the metal radiologically surveyed? Monitored? Yes No a. Surveyed by: Date:
L. If metal is releasable but not monitored explanation:
M. High Risk Property? Yes No
a. Comments:
N. Resource Conservation and Recovery Act (RCRA)? Yes No
a. If Yes, a Material Safety Data Sheet (MSDS) must be submitted along with this form to the Business Center
b. Comments:

Note 1:
All liabilities due to incorrect identification, categorization, radioactivity, and/or shipping requirements will be incurred by the originator.

Note 2:
Shipping instructions issued by Business Center will be limited to the materials listed above. Inclusion of additional materials at time of shipment will void the Business Center shipping instructions and will be cause for return of entire lot at shipper's expense.

Recipient Email *

Comments *

Last Updated: Monday, 29-Oct-2018

Note 1:	All liabilities due to incorrect identification, categorization, radioactivity, and/or shipping requirements will be incurred by the originator.
Note 2:	Shipping instructions issued by Business Center will be limited to the materials listed above. Inclusion of additional materials at time of shipment will void the Business Center shipping instructions and will be cause for return of entire lot at shipper's expense.