Wyo. Code R. 045-0004-2
CHAPTER II
RADIOACTIVE WASTE TRANSPORTATION (MOTOR CARRIER - RAILROAD)
37-14-103.
(g) Radioactive waste means;
(d) A permit may be denied or revoked for:
(ii) the revocation or cancellation:
(e) Permit application forms are available from the Wyoming Department of Transportation, Regulatory Section, 5300 Bishop Blvd., Cheyenne, Wyoming 82009, at all Wyoming Ports of Entry and at all Wyoming Highway Patrol offices. The application shall contain:
Applications shall be acted upon by the Department within thirty days of the date of the application.
During those thirty days, the applicant may transport radioactive waste as if a permit had been granted and shall pay all applicable emergency response fees and comply with all applicable rules and regula- tions concerning radioactive waste transportation.
(a) Each permit holder shall notify the Department within ten (10) days after any of the following shall occur;
RADIOACTIVE WASTE TRANSPORTATION PERMIT APPLICATION FORM for a PERMANENT PERMIT TEMPORARY PERMIT (only for one trip described below)
1. ___________________________________________________________________________ Name of Carrier
2. __________________________________________________________________________ Address and regular business telephone number of Carrier
3. __________________________________________________________________________ Contact Person and 24-hour emergency telephone number which will always be answered
4. General description of radioactive waste intended for transport, including type of material, estimate number of shipments and packages, description of packages and estimated radioactivity per shipment
(precise information not necessary if unavailable) :
_______________________________________________________________________________ ____________________________________________________________________________ ___
5. Description of mode of transportation, route or routes to be taken and approximate schedule (precise information not necessary if unavailable):
_______________________________________________________________________________ ____________________________________________________________________________ ___
6. Describe any violations by applicant of any local, state or federal regulations in the past year relating to radioactive waste transportation (if none, so state) (completion of this section is voluntary except in the case of an accident resulting in the release of radioactivity):
_______________________________________________________________________________ ____________________________________________________________________________ ___
7. Other information which would be of assistance in case of an accident involving radioactive waste
(completion of this section is voluntary) :
_______________________________________________________________________________ ____________________________________________________________________________ ___
READ CAREFULLY BEFORE SIGNING I hereby certify that the information given to obtain the requested permit is true and correct. I hereby certify that the carrier has a 24 hour telephone number for all of the persons for whom the carrier is transporting radioactive waste under the permit. The carrier agrees to pay all emergency response fees (at the rate of $200 per package transported) to become due under the rules and reporting requirements of the Wyoming Department of Transportation (Accounting Program) 5300 Bishop Blvd., Cheyenne, Wyoming 82009. The carrier agrees to obey all placarding and safety requirements for the transportation of radioactive waste as set forth in Title 49 of the Code of Federal Regulations (CFR). I understand that, if this application is for a permanent permit, I may trans- port radioactive waste within and through Wyoming for thirty (30) days after the date of application set forth below without a permit, that I will pay all applicable emergency response fees associated with such transportation and that I will obey all applicable radioactive waste transportation safety regulations during this time. I understand the carriers duty to provide supplemental information under the rules of the Wyoming Department of Transportation. I understand that, If this application is for a temporary permit, I may elect to pay my emergency response fees at the time the permit is granted or to pay quar- terly as billed to me by the Wyoming Department of Transportation (Accounting Program) 5300 Bishop Blvd., Cheyenne, Wyoming 82009. Based on the foregoing, I hereby apply for a permanent/temporary
(circle one) permit to transport radioactive waste within and through Wyoming.
Carrier Name:______________________________________________________________________
By: __________________________________________________Date_________________ Signature of Authorized Representative
Wyoming DOT Docket No. M-______________________Permit No. _________________
PERMIT TO TRANSPORT RADIOACTIVE WASTE (Issued pursuant to W.S. 37-14-103)
Granted to the above carrier, for radioactive waste transportation as described above, on _______________, 19 ____, at ________am pm (circle one) by _____________________ at _____________________, Wyoming. (Station and clerk number (for temporary permit) if applicable: ______________________________.)
_______________________________________ SIGNATURE OF ISSUING AUTHORITY
CARRIER PLEASE NOTE: This is one of two documents which must be carried to transport radioactive waste within or through Wyoming. Both the Emergency Response Fee Report for the load being transported and a copy of the Permit to Transport Radioactive Waste must be carried with the load being transported.
WYOMING DEPARTMENT OF TRANSPORTATION
RADIOACTIVE WASTE TRANSPORTATION PERMIT APPLICATION FORM for a PERMANENT PERMIT
1. _______________________________________________________________________ Name of Railroad
2. _______________________________________________________________________ Address and regular business telephone number of railroad
3. _______________________________________________________________________ Contact Person and 24-hour emergency telephone number will always be answered
4. General description of radioactive waste intended for transport, including type of material, estimated number of shipments and packages, description of packages and estimated radioactivity per shipment
(precise information not necessary if unavailable) :
____________________________________________________________________________ ____________________________________________________________________________
5. Description of mode of transportation, route or routes to be taken and approximate schedule (precise information not necessary if unavailable):
____________________________________________________________________________ ____________________________________________________________________________
6. Describe any violations by applicant of any local, state or federal regulations in the past year relating to radioactive waste transportation (if none, so state) (completion of this section is voluntary except in the case of an accident resulting in the release of radioactivity):
_____________________________________________________________________________ ____________________________________________________________________________ _
7. Other information which would be of assistance in case of an accident involving radioactive waste
(completion of this section is voluntary) :
_____________________________________________________________________________ ____________________________________________________________________________ _
READ CAREFULLY BEFORE SIGNING I hereby certify that the information given to obtain the requested permit is true and correct. I hereby further certify that the railroad has a 24 hour telephone number for all of the persons for whom the railroad is transporting radioactive waste under the permit.
The railroad agrees to pay all emergency response fees (at the rate of $200 per package transported) to become due under the rules and reporting requirements of the Wyoming Department of Transportation
(Accounting Program) , 5300 Bishop Blvd., Cheyenne, Wyoming 82009. The railroad agrees to obey all placarding and safety requirements for the transportation of radioactive waste. I understand that, under this application for a permanent permit, I may transport radioactive waste within and through Wyoming for thirty (30) days after the date of application set forth below without a permit, that I will pay all applicable emergency response fees associated with such transportation and that I will obey all appli- cable radioactive waste transportation safety regulations during this time. I understand the railroads duty to provide supplemental information under the rules of the Regulatory Section of the Department.
Based on the foregoing, I hereby apply for a permanent permit to transport radioactive waste within and through Wyoming.
RAILROAD Name: _________________________________________________________________________
By: ______________________________________________Date: _________________ Signature of Authorized Representative
PERMIT TO TRANSPORT RADIOACTIVE WASTE (Issued pursuant to W.S. 37-14-103) PERMANENT
Granted to the above, railroad for radioactive waste transportation as described above, on ______________, 19_____, at _______________am pm (circle one) by __________________ at _______________, Wyoming.
____________________________________ Signature of Issuing Authority
Wyo DOT Form RWT-1 (10-91) Railroads Wyo DOT Form RWT-1 (10-91) Motor Carrier