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 y12web4:
• 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.: Date of Application:

DESCRIPTION OF SCRAP

A. Physical Form and Shapes of Scrap

B. Net Weight of Scrap (exclusive of container)

C. PRECIOUS METAL CONTENT:

Metal Type: grams

D. Alloys, if any, and percentages

E. Known or suspected impurities and foreign matter (nonradioactive)

F. Radioactivity: Business Center does not accept radioactive contaminated metal.

Is this metal free releasable? Yes No
Has this metal ever been in a radiological area? Yes No

Monitored? Yes No By: Date:
If metal is releasable but not monitored explain:
G. High Risk Property? Yes No
High Risk Property Comments:
H. Resource Conservation and Recovery Act (RCRA)? Yes No
If Yes, a Material Safety Data Sheet (MSDS) must be submitted along with this form to the Business Center
RCRA 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.

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Last Update: Wednesday, 16-May-2012 15:59:01 EDT