编辑: 迷音桑 | 2019-07-09 |
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"医疗机构执业许可有效期限:",,
,"医疗卫生机构性质",,
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"编制床位数:",,
,"实有床位数:",,
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"病床使用率","(%)", ,"单位地址:",,
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,"法定代表人:",,
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"联系
电话:",,
,"医疗废物管理专(兼)职人员:",,
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"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",,
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, ,,
"上一年使用专用包装袋()个、利器盒()个、周转箱(桶)()个、贮存柜()个",,
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, "废物接受者","单位名称:","(例:重庆同兴医疗废物处理有限公司)",,
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, ,"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)",,
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, ,"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)",,
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"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)",,
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"法定代表人签字:","(纸质件此处必须手写)","签字日期:",,
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, "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",,
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"细菌病毒","公路", ,,
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, "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:",,
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"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) ,,
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