TNH/THNH PH

CHNG T CHT THI NGUY HI

B Ra Vng Tu
S: LLL-XXX/YYYY/77.000741.T
1. Ch ngun thi:. Cng ty iu hnh du kh Bin ng
M s QLCTNH: 77.000741.T
a ch vn phng: Centec Towers, Lu 7,S 72-74 Nguyn Th Minh Khai ,Q.3,TPHCM T: 08.38245566
a ch c sL 5.2 & 5.3
T:
2. Ch hnh ngh QLCTNH 1: Cng ty Tu Dch V Du kh
M s QLCTNH: 77.001.V
a ch vn phng:
73 ng 30/4, Phng Thng Nht, Thnh ph Vng Tu
T: 064.3838104
a ch c s/i l:
T: 064.3838104
3. Ch hnh ngh QLCTNH 2: Cng ty TNHH Xi mng Holcim Vit Nam
M s QLCTNH: i-2-3-4-5-6-7-8.010 VX
a ch vn phng:
81-83-83B-85 Hm Nghi, Q1, TP-HCM
T: 08.39149000
a ch c s (ni ti s dng): Nh my xi mng Holcim Hn Chng- quc l 80, x Bnh An, huyn Kin Lng, tnh Kin Giang;
T:0773854430
4. K khai CTNH chuyn giao (s dng thm trang ph lc cho bng di y nu khng ghi )
S
Tn CTNH
Trng thi tn ti
M CTNH
S lng
Phng php x l
TT
(kg)
(hoc ti s dng) #
Rn
Lng
Bn
1

Ghi ln lt k hiu ca phng php x l p dng i vi tng CTNH: TC (Tn thu/ti ch); TH (Trung ho); PT (Phn tch/chit/lc/kt ta); OH (Oxy ho); SH
(Sinh hc); X (ng x l); T (Thiu t); HR (Ho rn); CL (C lp/ng kn); C (Chn lp); Khc (ghi r tn phng php); Trng hp ti s dng th ghi: TSD

5. Xut khu CTNH (nu c)

Nc nhp khu:
S hiu phng tin:
Ngy xut cng:
7. Xc nhn vic tip nhn s lng v loi CTNH nh k khai mc 4

Ca khu nhp
Ca khu xut:

7.1. H tn ngi nhn thay mt ch hnh ngh QLCTNH 1: .....................................................K: Ngy:

7.2. H tn ngi nhn thay mt ch hnh ngh QLCTNH 2:......................K:..Ngy:
6. Ch ngun thi xc nhn thng nht k khai chnh
xc cc thng tin mc 1-4 (hoc 5)
.................. Ngy thng nm 2013

8. Ch hnh ngh QLCTNH (cui dng) xc nhn hon thnh vic x

l an ton tt c CTNH bng cc phng php nh k khai mc 4
(hoc ch ti s dng xc nhn ti s dng CTNH ng mc ch
ban u)
B Ra - Vng Tu, ngy
thng
nm 2013

(k, ghi h tn, chc danh, ng du)

@

Lin s: 1 - 2 2S - 2T - 3 - 3S - 3T - 4 - 5

(k, ghi h tn, chc danh, ng du)