Chief State Sanitary

Chief State Sanitary

doctor ______________ region


STATEMENT
to obtain a conclusion on compliance with sanitary
standards ob'єktіv ta sporud, scho introduced into ekspluatatsіyu ta
willingness to work for the enterprise authorization
at the beginning of the company, institution or organization

The applicant _______________________________________________________________

The owner of the company or authorized body

______________________________________________________________________

Enterprise __________________________________________________________

Name or its subdivision, on yakay seems conclusion

______________________________________________________________________

His departmental affiliation

______________________________________________________________________

Address, phone, fax, account number

The aim of treatment ________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________

Obruntuvannya readiness to the robot and transfer of documents, scheduling claims of sanctuary about sanctuary rules and rules _______________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The payment guarantee.

Director (owner) of the company

or authorized body Signature

MP date

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