Waste Management and Radiation Control Forms

DWMRC-01 Radioactive Material License Application

• DWMRC-01 Radioactive Material License Application (73 KB) | Interactive Form (187 KB)
  (01/16)

---

DWMRC-02A Series: Preceptor Attestations for Medical Use

• Licensing Guidance for Using the Form (136 KB)
  (02/16)—DWMRC-02A Series
• DWMRC-02A (AMP) (72 KB)
  (01/16)—Authorized Medical Physicist Training and Experience and Preceptor Attestation [10 CFR 35.51]
• DWMRC-02A (ANP) (52 KB)
  (01/16)—Authorized Nuclear Pharmacist Training and Experience and Preceptor Attestation [10 CFR 35.55]
• DWMRC-02A (AUD) (60 KB)
  (01/16)—Authorized User Training and Experience and Preceptor Attestation (for uses defined under 10 CFR 35.100, 35.200, and 35.500), [10 CFR 35.190, 35.290, and 35.590]
• DWMRC-02A (AUS) (85 KB)
  (01/16)—Authorized User Training and Experience and Preceptor Attestation (for uses defined under 10 CFR 35.400 and 35.600), [10 CFR 35.490, 35.491, and 35.690]
• DWMRC-02A (AUT) (94 KB)
  (01/16)—Authorized User Training and Experience and Preceptor Attestation (for uses defined under 10 CFR 35.300), [10 CFR 35.390, 35.392, 35.394, and 35.396]
• DWMRC-02A (RSO) (94 KB)
  (01/16)—Radiation Safety Officer Training and Experience and Preceptor Attestation [10 CFR 35]
• DWMRC-02A (AUD-RSL) (39 KB)
  (01/16)—Authorized User Training and Experience and Preceptor Attestation for uses defined under 10 CFR 35.1000 for Radioactive Seed Localization

---

DWMRC-04 through DWMRC-26 Series

• DWMRC-04: Notice to Employees (199 KB)
  (08/18)
• DWMRC-04SP: Aviso a los Empleados (46 KB)
  (08/15)
• DWMRC-05: Cumulative Occupational Exposure History (56 KB)
  (01/16)
• DWMRC-06: Occupational Exposure Record (71 KB)
  (01/16)
• DWMRC-07: In Vitro Testing under General License—Registration Form (97 KB)
  (01/16)
• DWMRC-10: X-ray Machine Registration Application (169 KB)
  (01/16)
• DWMRC-12: Use of Depleted Uranium—Registration Form (140 KB)
  (01/16)
• DWMRC-13: Certain Measuring, Gauging or Controlling Devices Under General License—Registration Form (88 KB)
  (01/16)
• DWMRC-14: Radioactive Material License Termination (59 KB)
  (01/16)
• DWMRC-26: Generator Site Access Permit Application (36 KB)
  (01/15)

---

Other Radiation Forms

• Generator Site Access Permit System
• Model Delegation of Authority to RSOs (15 KB)
• New, Transfer and Disposed-of X-ray Equipment Form (66 KB)
  (01/16)
• Request for Public Information (110 KB) | Fee Policy
  (10/05/12)
• X-Ray Assembler Notification (14 KB)
• X-Ray Program Forms

---

General Forms

• Drum-Top Lamp Crusher Registration Application (248 KB)
• Drum-Top Lamp Crusher Inspection (46 KB)
• Notification of Regulated Activities Form (EPA Form 8700-12)
• Records Request (GRAMA) Form (134 KB)
• Small Business Assistance Form (DWMRC) (338 KB)
• WMRC/Template for Environmental Covenants (45 KB)
• Template for Request for Comfort Letter (26 KB)
• Template for Application for an Enforceable Written Assurance Letter (23KB)

---

Solid Waste Program Forms

Annual Report Forms

• Compost Facility Annual Report Form: DOC (28 KB) | PDF (128 KB)
• Incinerator Annual Report Form: DOC (29 KB) | PDF (137 KB)
• Landfill Annual Report Form: DOC (31 KB) | PDF (199 KB)
• Landspreading Facility Annual Report Form: DOC (23 KB) | PDF (187 KB)
• Post-Closure Care Annual Report Form: DOC (26 KB) | PDF (122 KB)
• Recycling Facility Annual Report Form: DOC (31 KB) | PDF (136 KB)
• Tire Storage Facility Annual Report Form: DOC (27 KB) | PDF (213 KB)
• Transfer Station Annual Report Form: DOC (29 KB) | PDF (148 KB)

Quarterly Report Forms

• Quarterly Fee Report Form: DOC (56 KB) | PDF (233 KB)

---

Used Oil Forms

Annual Report Forms

• Annual Report Guidelines (18 KB)
• Annual Report for Off-Specification Used Oil Fuel Burners (203 KB)
• Annual Report for Used Oil Processors (341 KB)
• Annual Report for Used Oil Transfer Facilities (294 KB)
• Annual Report for Used Oil Transporters (213 KB)

Application Forms

• Application for Used Oil Collection Center (90 KB)
  • Used Oil Collection Center Log Sheets: DOC (66 KB) | PDF (272 KB)
• Application for Used Oil Marketer (627 KB)
• Application for Used Oil Processors/Re-refiners (456 KB)
• Application for Used Oil Transporter (388 KB)
• Application for Used Oil Transfer Facility (480 KB)
• Application for Used Oil Off-Specification Burner (310 KB)
• 10-Year Renewal Application for Transporters (610 KB)
• Used Oil Grant Package and Application (251 KB)

Financial Forms (R315-15-10 and R315-15-12)

• Form 17.2: DOC (41 KB) | PDF (33 KB)
  Trust agreements.
• Form 17.3: DOC (30 KB) | PDF (20 KB)
  Surety bond guaranteeing payment into a standby trust agreement trust fund.
• Form 17.4: DOC (26 KB) | PDF (16 KB)
  Irrevocable standby letter of credit with standby trust agreement.
• Form 17.5: DOC (29 KB) | PDF (19 KB)
  Insurance endorsement of clean-up and closure.
• Form 17.6: DOC (29 KB) | PDF (19 KB)
  Used oil transporter pollution liability endorsement for sudden occurrence.
• Form 17.7: DOC (22 KB) | PDF (19 KB)
  Used oil pollution liability endorsement for sudden occurrences.
• Form 17.8: DOC (29 KB) | PDF (19 KB)
  Used oil pollution liability endorsement for non-sudden occurrences.
• Form 17.9: DOC (29 KB) | PDF (19 KB)
  Used oil pollution liability endorsement for sudden and non-sudden occurrences.
• Form 17.10: DOC (29 KB) | PDF (20 KB)
  Letter of Credit for third-party damages from environmental pollution liability with optional standby trust agreement to be used by transfer, processor, re-refiner, or off-specification burner facility.
• Form 17.11: DOC (38 KB) | PDF (25 KB)
  Payment bond for third-party damages from environmental pollution liability to be used by transfer, processor, re-refiner, or off-specification burner facility.
• Form 17.12: DOC (45 KB) | PDF (39 KB)
  Trust agreement for for third-party damages from environmental pollution liability to be used by transfer, processor, re-refiner, or off-specification burner facility.
• Form 17.13: DOC (43 KB) | PDF (37 KB)
  Standby trust agreement, if and when applicable to certain financial mechanisms associated with third-party damages from environmental pollution liability requiring a standby trust agreement to be used by transfer, processor, re-refiner, or off-specification burner facility.
• Form 17.14: DOC (47 KB) | PDF (47 KB)
  Standby trust agreement, if and when applicable to certain financial mechanisms requiring a standby trust agreement, other than liability, to be used by transfer, processor, re-refiner, or off-specification burner facility.

---

Waste Tire Forms

• Waste Tire Recycler Registration Application (314 KB)
• Waste Tire Storage Application and Checklist (197 KB)
• Waste Tire Transporter Registration Application (627 KB)