DHEC Form 803 "Radioactive Waste Shipment Certification Form" - South Carolina

What Is DHEC Form 803?

This is a legal form that was released by the South Carolina Department of Health and Environmental Control - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 1980;
  • The latest edition provided by the South Carolina Department of Health and Environmental Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DHEC Form 803 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Health and Environmental Control.

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Download DHEC Form 803 "Radioactive Waste Shipment Certification Form" - South Carolina

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SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Radioactive Waste Shipment Certification Form
General Instructions and Information: This is a two part form to be used by shippers and carriers of radioactive waste. The
certifications contained herein satisfy the requirements of Section 13-7-150, of Act No. 499 of 1980, the South Carolina
Radioactive Waste Transportation and Disposal Act. This certification along with a copy of the prior notification form shall
accompany each shipment of radioactive waste into or within the State of South Carolina. The shipper is to complete his
portion of the form and present it to the carrier as part of the shipping documents. Upon receipt, the carrier shall complete
his portion of the form. Upon delivery of the shipment to the consignee, a copy of this certification form, and a copy of the
Prior Notification and Manifest form with the consignee acknowledgment, shall be returned to the Department.
Part I. Shipper’s Certificate of Compliance
1. Name of Shipper and Address:
2. Shipment Identification No.
3. Transport Permit No.
Telephone No. (
)
In compliance with Act No. 499 of 1980, the South Carolina Radioactive Waste Transportation and Disposal Act, I hereby
certify on behalf of the above-named shipper to the South Carolina Department of Health and Environmental Control that
the above-named shipper has complied with all provisions of Act No. 499 of 1980, and all applicable laws and
administrative rules and regulations, both State and Federal, regarding the packaging, transportation, storage, disposal and
delivery of such wastes. I further certify that this shipment of radioactive waste has been inspected within 48 hours of the
time of departure and that no items of non-compliance with applicable laws, rules or regulations were found.
_____________________________________
Date
_________________________________________
________________________________________
Typed Name and Title of Agent of Shipper
Signature
Part II. Carrier’s Certification
1. Name of Carrier and Address:
2. Shipment Identification No.
3. Transport Trailer No.
Telephone No. (
)
4. Scheduled Date of Departure of Shipment
5. Estimated Date of Arrival of Shipment
Certification is hereby made to the South Carolina Department of Health and Environmental Control that: (a) the shipper
has provided the carrier with a copy of the shipment manifest, the certificate of compliance, and the routing instructions;
(b) the shipment of radioactive waste has been properly placarded for transport according to applicable U.S. Department
of Transportation Regulations; (c) all shipping papers originated or reproduced by the carrier have been properly executed;
(d) the transport vehicle has been inspected according to applicable State and Federal regulations within the prescribed
intervals and that all safety and operational components are in good working order and meet the requirements of regulations;
(e) all drivers who will operate the vehicle within the State of South Carolina are qualified to transport hazardous materials
as specified by applicable U.S. Department of Transportation Regulations; (f) the Department shall be immediately notified
of any variance, occurring after departure, from the shipper’s notification of primary routes in South Carolina and estimated
date of arrival; (g) all applicable laws and administrative rules and regulations, both State and Federal, regarding the
transportation of radioactive wastes will be complied with.
_____________________________________
Date
_________________________________________
________________________________________
Typed or Printed Name and Title
Signature
DHEC: 803 (5/80)
(Copies of this form may be reproduced locally as needed)
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SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Radioactive Waste Shipment Certification Form
General Instructions and Information: This is a two part form to be used by shippers and carriers of radioactive waste. The
certifications contained herein satisfy the requirements of Section 13-7-150, of Act No. 499 of 1980, the South Carolina
Radioactive Waste Transportation and Disposal Act. This certification along with a copy of the prior notification form shall
accompany each shipment of radioactive waste into or within the State of South Carolina. The shipper is to complete his
portion of the form and present it to the carrier as part of the shipping documents. Upon receipt, the carrier shall complete
his portion of the form. Upon delivery of the shipment to the consignee, a copy of this certification form, and a copy of the
Prior Notification and Manifest form with the consignee acknowledgment, shall be returned to the Department.
Part I. Shipper’s Certificate of Compliance
1. Name of Shipper and Address:
2. Shipment Identification No.
3. Transport Permit No.
Telephone No. (
)
In compliance with Act No. 499 of 1980, the South Carolina Radioactive Waste Transportation and Disposal Act, I hereby
certify on behalf of the above-named shipper to the South Carolina Department of Health and Environmental Control that
the above-named shipper has complied with all provisions of Act No. 499 of 1980, and all applicable laws and
administrative rules and regulations, both State and Federal, regarding the packaging, transportation, storage, disposal and
delivery of such wastes. I further certify that this shipment of radioactive waste has been inspected within 48 hours of the
time of departure and that no items of non-compliance with applicable laws, rules or regulations were found.
_____________________________________
Date
_________________________________________
________________________________________
Typed Name and Title of Agent of Shipper
Signature
Part II. Carrier’s Certification
1. Name of Carrier and Address:
2. Shipment Identification No.
3. Transport Trailer No.
Telephone No. (
)
4. Scheduled Date of Departure of Shipment
5. Estimated Date of Arrival of Shipment
Certification is hereby made to the South Carolina Department of Health and Environmental Control that: (a) the shipper
has provided the carrier with a copy of the shipment manifest, the certificate of compliance, and the routing instructions;
(b) the shipment of radioactive waste has been properly placarded for transport according to applicable U.S. Department
of Transportation Regulations; (c) all shipping papers originated or reproduced by the carrier have been properly executed;
(d) the transport vehicle has been inspected according to applicable State and Federal regulations within the prescribed
intervals and that all safety and operational components are in good working order and meet the requirements of regulations;
(e) all drivers who will operate the vehicle within the State of South Carolina are qualified to transport hazardous materials
as specified by applicable U.S. Department of Transportation Regulations; (f) the Department shall be immediately notified
of any variance, occurring after departure, from the shipper’s notification of primary routes in South Carolina and estimated
date of arrival; (g) all applicable laws and administrative rules and regulations, both State and Federal, regarding the
transportation of radioactive wastes will be complied with.
_____________________________________
Date
_________________________________________
________________________________________
Typed or Printed Name and Title
Signature
DHEC: 803 (5/80)
(Copies of this form may be reproduced locally as needed)
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