Atch(1-2)_APPENDIX_K__A0001.pdf

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MEDICAL WASTE COLLECTION TRANSPOTATION AND DISPOSAL SERVICES
Solicitation number
N4008419T5404
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Atch(1-2)_APPENDIX K _A0001

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Text version

A0001

To: NFBC Iwakuni and 11th Dental Company Detachment Date: DD/MMM/YYYY

USMC Iwakuni Contractor:(Contractor's name)

(Contractor's address)

The following indicated amount of Hazardous Materials were collected by:

下記に示す数量の医療廃棄物を回収しました。

Truck Driver's Signature 運転者署名

XX.X (kg)

XX.X (kg)

X.X (kg)

TOTAL XX.X (kg)

XX.X (kg)

X.X (kg)

TOTAL XX.X (kg)

The above weight is confirmed by Clinic Personnel:

(Signature of designated Government Representative (Supported Command))

BIOHAZARDOUS MEDICAL WASTE CONTAINER

DELIVERING AND RECEIVING CHIT

Infectious Waste (感染性廃棄物)

NFBC

APPENDIX K

SAMPLE COLLECTED MEDICAL WASTE QUANTITY CHIT

XX (kg)XX 袋NFBC

Weight (重量)

Dental XX (kg)XX 袋 containers

Pathology (Frozen)

Regular

Regular

Dental

Non-Infectious Waste (非感染性廃棄物)

# of Bags (数量)

Weight (重量) containers

APPENDIX K - 1 of 2

A0001

To: Veterinary Clinic Date: DD/MMM/YYYY

USMC Iwakuni Contractor: (Contractor's name)

(Contractor's address)

The following indicated amount of Hazardous Materials were collected by:

下記に示す数量の医療廃棄物を回収しました。

Truck Driver's Signature 運転者署名

XX.X (kg)

XX.X (kg)

X.X (kg)

XX.X (kg)

The above weight is confirmed by VET Clinic Personnel:

(Signature of designated Government Representative (Supported Command))

VET

(NFBC)

Regular VET

(NFBC)

XX 袋 XX (kg)

Animal Carcass(es)

TOTAL

containers

APPENDIX K

SAMPLE COLLECTED MEDICAL WASTE QUANTITY CHIT

BIOHAZARDOUS MEDICAL WASTE CONTAINER

DELIVERING AND RECEIVING CHIT

Infectious Waste (感染性廃棄物) Non-Infectious Waste (非感染性廃棄物)

Weight (重量) # of Bags (数量) Weight (重量)

APPENDIX K - 2 of 2

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