Tabulka č. 2d
+--------------------------------------------------------------------------------------------------------+
| Seznam regulovaných látek, které osoba přijala a zneškodnila na základě |
| povolení podle § 4 odst. 1 písm. d) (pozn. zneškodnění regulovaných látek) |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| Datum | Název osoby, od které | Číslo povolení osoby, od | Označení látky | Přijaté a zneškodněné |
| | byla regulovaná látka | které byla regulovaná | nebo chem. vzorec | množství (kg) |
| | přijata | látka přijata | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| | | | | |
+-------+-----------------------+--------------------------+-------------------+-------------------------+
| |
| |
| |
| |
| |
| |
| |
| |
| Dne: ............ Podpis oprávněné osoby: .......... |
| (razítko) |
+--------------------------------------------------------------------------------------------------------+