EHS FORM NO.

112
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF HEALTH REGION ____
Municipal Health Office
Date: _______________

MISSION ORDER

Bearer of this _______________________________ of the Municipal Health

Office, with I.D. No. ________ is authorized by the undersigned to conduct inspection
and evaluation of business establishments in his assigned area and to enforce P.D. 522
Implementing Rules and Regulation/P.D. 856 and Municipal Ordinance No. ___________

BUSINESS NAME ADDRESS DATE

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Sanitation Inspector II