Office of the City/Municipal Health Officer

Buenavista,Quezon

_________________

Sanitary Order
Name:_________________________________________________
Address:_______________________________________________
Name of Establishment:__________________________________

Sir/Madam:
An inspector of your premises/establishment was made on
________________________and the defect listed on the left column below are
observed.Please correct defects within the time stated hereunder.Corresponding
correction for each defect/violation is listed in the right column.
Sanitary Defect Recommended Correction
/Action

A reinspection of your premises/establishment shall be made after

the lapse of the time given for correction in order to determine compliance
with this notice.Non-compliance would be a violation of P.D. 522
Implementing Rules and Regulations /P.D 856 and City/Municipal
Ordinance No.______________s_________and render you lable for
prosecution

Date__________________________
Delivered by___________________
Received by____________________

Respectfully,
_______________________
Sanitation Inspector

_______________________
Municipal Health Officer