Příloha č. 9A
Hlášení o produkci a nakládání s odpady +-+-+-+-+-+
za rok. ..... Evidenční číslo | | | | | |
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| Původce nebo oprávněná osoba | Samostatná provozovna |
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| Firma (název): | Název provozovny: |
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| Ulice: | Ulice: |
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| Místo: | Místo: |
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| PSČ: | | | | | | PSČ: | | | | | |
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| IČO: | | | | | | | | | Číslo provozovny: | | | | |
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| Kód okresu: | | | | | Kód okresu: | | | | |
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| Kód ZÚJ: | | | | | | | Osoba oprávněná jednat jménem firmy: |
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| Produkce odpadů firmy celkem: | Telefon, FAX: |
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| Datum vyhotovení dokladu: | | | | | | | Produkce odpadů provozovny celkem: |
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| Razítko a podpis: | Místo nakládání s odpadem: |
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| | Název obce (ZÚJ): |
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| | Kód ZÚJ: | | | | | | |
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+--------+--------------------+-------------------------+---------+--------------------------+--------------------------------+-------+
| Pořad. | Kód druhu odpadu | Název druhu odpadu dle | Kateg. | Množství odpadu (t) | Způsob nakládání s odpadem | Pozn. |
| číslo | dle Katalogu odp. | Katalogu odpadů | odpadu +-----------+--------------+-------------+------------------+ |
| | | | | celkem | z toho dle | Kód způsobu | IČO, název, | |
| | | | | | sloupce 7 | nakládání | sídlo nebo místo | |
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| IČO | | | | | | | | | Číslo provozovny | | | | |
+--------------------------------------------------+-+-+-+-+-+-+-+-+----------------------------------------------------------+-+-+-+-+
+--------+--------------------+------------------------+---------+---------------------------+--------------------------------+-------+
| Pořad. | Kód druhu odpadu | Název druhu odpadu dle | Kateg. | Množství odpadu (t) | Způsob nakládání s odpadem | Pozn. |
| číslo | dle Katalogu odp. | Katalogu odpadů | odpadu +-----------+---------------+-------------+------------------+ |
| | | | | celkem | z toho | Kód způsobu | IČO, název, | |
| | | | | | dle sloupce 7 | nakládání | sídlo nebo místo | |
+--------+--------------------+------------------------+---------+-----------+---------------+-------------+------------------+-------+
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
+--------+--------------------+------------------------+---------+-----------+---------------+-------------+------------------+-------+
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