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Q-2, r. 12 - Regulation respecting biomedical waste
Schedule
Disposition versions
SCHEDULE II
(s. 15)
ANNUAL REPORT OF THE OPERATOR OF A FACILITY THAT TREATS BIOMEDICAL WASTE OFF ITS GENERATION SITE, A FACILITY THAT STORES BIOMEDICAL WASTE OFF ITS GENERATION SITE OR OF A SYSTEM THAT TRANSPORTS BIOMEDICAL WASTE
SCHEDULE II
(s. 15)
ANNUAL BIOMEDICAL WASTE MANAGEMENT REPORT
□ Transport □ Disinfection □ Storage □ Incineration
________________________________________________________________________________
| |
|OPERATOR |
| |
|Name: _______________ Municipality: ________________ Postal Code: ______________|
| |
|Address: ____________ Province/State:_______________ |
| |
| ____________ Country: _____________________ |
| |
|PERSON IN CHARGE |
| |
|Name: _______________ Signature: ___________________ Telephone No.: ____________|
| |
|Title: ______________ Date: ________________________ |
| |
|________________________________________________________________________________|
| | | | |
| GENERATOR | TOTAL | CARRIER | CONSIGNEE |
| | QUANTITY | | |
| | (Kg) | □ Same as | □ Same as |
| | | above or: | above or: |
|___________________|________________|______________________|____________________|
| | | | |
|Name: _____________| |Name: _____________ |Name: ______________|
| | | | |
|Address: __________| |Address: __________ |Address: ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| | |Authorization No.: |Authorization No.: |
| | | __________ | ___________|
|___________________|________________|______________________|____________________|
| | | | |
| | | | |
|Name: _____________| |Name: _____________ |Name: ______________|
| | | | |
|Address: __________| |Address: __________ |Address: ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| | |Authorization No.: |Authorization No.: |
| | | __________ | ___________|
|___________________|________________|______________________|____________________|
| | | | |
| | | | |
|Name: _____________| |Name: _____________ |Name: ______________|
| | | | |
|Address: __________| |Address: __________ |Address: ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| | |Authorization No.: |Authorization No.: |
| | | __________ | ___________|
|___________________|________________|______________________|____________________|
SCHEDULE II
(s. 15)
ANNUAL BIOMEDICAL WASTE MANAGEMENT REPORT
□ Transport □ Disinfection □ Storage □ Incineration
________________________________________________________________________________
| |
|OPERATOR |
| |
|Name: _______________ Municipality: ________________ Postal Code: ______________|
| |
|Address: ____________ Province/State:_______________ |
| |
| ____________ Country: _____________________ |
| |
|PERSON IN CHARGE |
| |
|Name: _______________ Signature: ___________________ Telephone No.: ____________|
| |
|Title: ______________ Date: ________________________ |
| |
|________________________________________________________________________________|
| | | | |
| GENERATOR | TOTAL | CARRIER | CONSIGNEE |
| | QUANTITY | | |
| | (Kg) | □ Same as | □ Same as |
| | | above or: | above or: |
|___________________|________________|______________________|____________________|
| | | | |
|Name: _____________| |Name: _____________ |Name: ______________|
| | | | |
|Address: __________| |Address: __________ |Address: ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| | |Permit No.: _______ |Permit No.: _______ |
|___________________|________________|______________________|____________________|
| | | | |
| | | | |
|Name: _____________| |Name: _____________ |Name: ______________|
| | | | |
|Address: __________| |Address: __________ |Address: ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| | |Permit No.: _______ |Permit No.: _______ |
|___________________|________________|______________________|____________________|
| | | | |
| | | | |
|Name: _____________| |Name: _____________ |Name: ______________|
| | | | |
|Address: __________| |Address: __________ |Address: ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| __________| | __________ | ___________|
| | | | |
| | |Permit No.: _______ |Permit No.: _______ |
|___________________|________________|______________________|____________________|
