Name of Institution: GOLDEN PRIME INSTITUTE FOR TECHNOLOGY SERVICES, INC. Facility Description Quantity Inspector’s Remarks A. Building (Permanent) Lecture Area 40 square meters 1 Learning resource center 10 square meters 1 Laboratory/ Practice Area 40 square meters 1 Washroom (female) 4 square meters 1 Washroom (male) 4 square meters 1 Stock room 4 square meters 1 B. Experimental farm 10,000 sq.m (1 ha) 1
Note: Columns 1-3 to be filled out by Institution/Company; Column 4 to be filled out by PO/Expert Continue in additional sheet
Submitted by: Attested by:
RAISA Y. TAN STENILY Y TAN
Corporate Secretary/ Institution Representative/ President/ Institution Head/ School Administrator/ School Registrar/ Librarian Cashier Date: Date: Inspected by: