§ 961.11
10 CFR Ch. III (1–1–12 Edition)
Other (Identify) llllllllllllll Facility Description llllllllllll Date of Commencement of Operation llll (actual or estimated) NRC License #: lllllllllllllll By Purchaser: Signatue llllllllllllllllll Title lllllllllllllllllllll Date lllllllllllllllllllll A PPENDIX B Ten Year Discharge Forecast To be used for DOE planning purposes only and does not represent a firm commitment by Purchaser.
Purchaser llllllllllllllllll Contract Number/Date llll / lllllll Reactor/Facility Name lllllllllll Location: Street llllllllllllllllllll City lllllllllllllllllllll County/State llll / llllllllllll Zip Code Type: BWR b PWR b Other (Identify) lllllllllllllll
10 yr total
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Discharge date—mo/yr (or refueling shut down date). Metric tons: —initial. —discharged. Number of assemblies discharged (per cycle).
By Purchaser:
Purchaser llllllllllllllllll Contract Number/Date lllllllllll Reactor/Facility Name lllllllllll Location: Street llllllllllllllllllll City lllllllllllllllllllll County/State llllllllllllllll Zip Code lllllllllllllllllll Type Cask Required: llllllllllll Shipping Lot Number llllllllllll (Assigned by DOE) Proposed Shipping Mode: Truck b Rail b Barge b DOE Assigned Delivery Commitment Date l Range of Discharge Date(s) (Earliest to Lat- est) Mo ll Day ll Yr ll to Mo ll Day ll Yr ll Metric Tons Uranium: (Initial) lllllllllllllllllll (Discharged) lllllllllllllllll Number of Assemblies: BWR lllllllllllllllllllll PWR lllllllllllllllllllll Other llllllllllllllllllll Unless otherwise agreed to in writing by DOE, the Purchaser shall furnish herewith to DOE suitable proof of ownership of the SNF and/or HLW to be delivered hereunder. The Purchaser shall notify DOE in writing at the earliest practicable date of any change in said ownership. Any false, fictitious or fraudulent state- ment may be punishable by fine or imprison- ment (U.S. Code, Title 18, Section 1001). By Purchaser: Signature llllllllllllllllll
Signature llllllllllllllllll Title lllllllllllllllllllll Date lllllllllllllllllllll A PPENDIX B (E NCLOSURE 1) Actual Discharges Purchaser llllllllllllllllll Contract Number/Date lllllllllll Reactor/Facility Name lllllllllll Location: Street llllllllllllllllllll City lllllllllllllllllllll County/State llllllllllllllll Zip Code lllllllllllllllllll Type: Other (Identify) lllllllllllllll Refueling Shutdown Date llllllllll Metric Tons Uranium (Initial/Discharged); Initial llllllllllllllllllll Discharged lllllllllllllllll Number of Assemblies Discharged: lllll Any false, fictitious or fraudulent state- ment may be punishable by fine or imprison- ment (U.S. Code, Title 18, Section 1001). By Purchaser: Signature llllllllllllllllll Title lllllllllllllllllllll Date lllllllllllllllllllll A PPENDIX C Delivery Commitment Schedule This delivery commitment schedule shall be submitted by Purchaser to DOE as speci- fied in Article V.B. of this contract. BWR b PWR b
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