South Carolina Code of Regulations
Chapter 61 - DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Subchapter 61-83 - Transportation of Radioactive Waste Into or Within South Carolina
Attachment III - Form RHA-CT "Radioactive Waste Shipment Certification Form"
Current through Register Vol. 48, No. 9, September 27, 2024
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. 429 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 and 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 acknowledgement,
shall be returned to the Department.
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Part I: Shipper's Certificate of Compliance
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1. Name of Shipper and Address: :
2. Shipment Identification No.
:
: -------------------------------------:
3. Transport Permit No.
Telephone No. () :
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In compliance with Act No. 429 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. 429 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 Signature
Shipper
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Part II: Carrier's Certification
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1. Name of Carrier and Address: :
2. Shipment Identification No.
:
: -------------------------------------
:
3. Transport Trailer No.
Telephone No. () :
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4. Scheduled Date of Departure of :
5. Estimated Date of Arrival of
Shipment: : Shipment:
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Certification is hereby made to the South Carolina Department of Health and Environmental Control that:
copy of the shipment manifest, the certificate of compliance, and the routing instructions;
will be complied with.
Date_________________________________
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W
4
0
_____________________________________ _____________________________________
Typed or Printed Name and Title Signature
DHEC 803
(5/80) (Copies of this form may be reproduced locally as needed)
