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Date Received%<br />

• I INFORMATION RELEASE REQUEST<br />

I Reference:<br />

4 /,h/ d3 i WHC-CM-3-4<br />

q<br />

_.<br />

SpeechorPresentation<br />

.PUr se- __--- -_-_-q<br />

Reference<br />

- 1 ID- N:abar (inelude revision, volume,<br />

WHC-SD-W100-TI-003 Rev. 0<br />

etc.)<br />

[I<br />

[]<br />

F ull Paper<br />

Summary<br />

(Check<br />

only one<br />

suffix)<br />

[x]<br />

q<br />

[]<br />

Technical Report<br />

Thesis or Dissertation<br />

Manual<br />

L i st attachments.<br />

[] Abstract [] Brochure/Flier appendices A through G<br />

[] Visual Aid [] Software/Database<br />

[] Speakers Bureau [] Controlled <strong>Document</strong><br />

Date Release Required<br />

[] Poster Session Q Other 4/6/93<br />

t] Videotape<br />

Title WRAP Module 2A Waste Form Qualification Status Unclassified Category Impact<br />

Level 4<br />

Rep ort UC-NA<br />

New or novel (patentable) subject matter) [ X] No [ l yes<br />

f 'Ves', has disclosure been submitted by WHC or other company7<br />

Information received from others in confidence, such as proprietary data,<br />

trade secrets, and/or inventions)<br />

[l No [l Yes Discbsure Nolsl.<br />

[X] No [ l Yes (Identify)<br />

Copyrights? [X] No [l Ves<br />

Trademarksi<br />

If'Ves-,haswrittenpermisaionbeenprantedT [l No [Xl Veslldentify) Sorbond, Envirostone,<br />

[1 No [1 Yes IAttach Permissionl Cel1 te, Hobart<br />

tle of Journal<br />

or Meeting I Group or Society Sponsoring<br />

Conference or Meeting I City/State I Willproceedinpsbepublished7 [l Yes<br />

Re view Required per WHC-CM-3-4<br />

tesification/UnclesaifiedControlled<br />

clear Information<br />

Patent - General Counsel<br />

eneral Counsel -<br />

Applied Technology/Export Controlled<br />

Information or International Program<br />

WHC Program/Project<br />

Communications<br />

RL Proaram/Project<br />

Publication Services<br />

Other Program/Project<br />

References Available to Intended Audience<br />

Transmit to DOE-HQ/Office of Scientific<br />

and Technical Information<br />

Will material be handed out? [] Yes<br />

Yes No Reviewer - Signature Indicates Approval<br />

Name (printed) Signature<br />

[l [ X'- l+ ,<br />

r"<br />

WC1p;<br />

W<br />

[l 1XI<br />

[l 1XI ,<br />

[l 1XI<br />

[l 1XI<br />

1XI [l<br />

[l 1XI<br />

e reauirements.<br />

Yes No<br />

1XI [l<br />

[l 1XI<br />

Author/Requestor rinted/Signeture) Date<br />

CJ Benar<br />

Intended Audi ce<br />

VW<br />

[l internal all sponsor ^ External<br />

-sponsible Manager ( Print gp/ Stgnature) Date<br />

r.^A Petersen 4/2/93<br />

BD-7600-062 ( 08/91) WEF074<br />

4/2/93<br />

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