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:
• 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.

BCPMS&R 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)

Radioactivity: BCPMS&R 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:

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 BCPMS&R will be limited to the materials listed above. Inclusion of additional materials at time of shipment will void the BCPM&R shipping instructions and will be cause for return of entire lot at shipper's expense.

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Last Update: Wednesday, 31-May-2006 10:23:41 EDT

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 BCPMS&R will be limited to the materials listed above. Inclusion of additional materials at time of shipment will void the BCPM&R shipping instructions and will be cause for return of entire lot at shipper's expense.