XLS《gfzy_zysq》

"南岸区医疗废物转移联单申领表(2018年版) "废物移出者","医疗机构名称(盖章) ,"医疗机构执业许可证登记号:",,

,,

"医疗机构执业许可有效期限:",,

,"医疗卫生机构性质",,

,,

"编制床位数:",,

,"实有床位数:",,

,,

"病床使用率","(%)", ,"单位地址:",,

,,

,,

,"法定代表人:",,

,,

"联系

电话:",,

,"医疗废物管理专(兼)职人员:",,

,,

"联系

电话:",,

,"上年产生量:","(吨)",,

,"上年处置量:","(吨)", ,"贮存措施:","已使用专用暂存库房面积()平米",,

,,

, ,,

"上一年使用专用包装袋()个、利器盒()个、周转箱(桶)()个、贮存柜()个",,

,,

, "废物接受者","单位名称:","(例:重庆同兴医疗废物处理有限公司)",,

,,

, ,"单位地址:","(例:重庆市北碚区童家溪镇五星村田坝子社)",,

,"邮政编码:","(例:400709)", ,"法定代表人:","(例:徐高九)",,

,"联系

电话:","(例:68348812)", ,"联系人:","(例:胡晓)",,

,"联系

电话:","(例:13983877383)", "废物运输者","单位名称:","(例:重庆同兴医疗废物处理有限公司)",,

,,

, ,"单位地址:","(例:重庆市北碚区童家溪镇五星村田坝子社)",,

,"邮政编码:","(例:400709)", ,"法定代表人:","(例:徐高九)",,

,"联系

电话:","(例:68348812)", ,"联系人:","(例:胡晓)",,

,"联系

电话:","(例:13983877383)", "医疗废物转移频次","(不超过2天/次)",,

,,

"所在片区(街镇、小组):",,

"其他医疗废物处置去向(19床以上必填)","(病理性废物、药物性废物、化学性废物处理去向,需提供处置合同或情况说明)",,

,,

,,

"法定代表人签字:","(纸质件此处必须手写)","签字日期:",,

,,

, "废物种类(类别)","编号","医疗废物数量(吨)","包装方式","形态","主要有害成分及含量","运输方式","备注" "医疗废物","HW01",,

,,

"细菌病毒","公路", ,,

,,

,,

, "联单编号","按照《中华人民共和国固体废物污染环境防治法》的有关规定,发放重庆市危险废物转移联单(医院临床废物专用),有效期至2018年月日.

领取联单编号:申领日期:",,

,,

,,

"注:

1、申请表一式两份,环保局、申请单位各留存一份;

2、表中有红色字体处需删除后填写,提交纸质件时法定代表人签字栏必须手写;

3、五联单每月填写并按时报送报送当地环保局(每季度报送一次,未报送单位不予发放下年度联单) ,,

,,

,,