QUEZON CITY HEALTH DEPARTMENT FORM 1 Date of Application_____________ Transaction Number ___________ Name of Establishment ______________________________________ Address________________________________ Owner _________________________________ Designated Representative ______________________________________ Mission Order is issued to Sanitation Inspector who will conduct inspection within 10 days from the receipt of your application for the issuance of Sanitary Permit Inspection reports and sanitary orders issued by Sanitation Inspectors must be acknowledged and signed by the owner/manager Laboratory results (stool & sputum) shall remain valid for three months from the date of application for the issuance of health certificates Official Receipts and results of laboratory tests must be dated within the current year (2016) ONLY those laboratory results and water test analysis from diagnostic/laboratory clinics and water testing laboratory RECOGNIZED by the QCHealth Department shall be accepted. Please see official website for the list of recognized facilities Sanitation Inspectors shall not endorse a particular water testing and diagnostic/clinical laboratory to conduct testing of water and specimens. FORM 1 Date of Application_____________ Transaction Number ___________ Name of Establishment ______________________________________ Address________________________________ Owner _________________________________ Designated Representative ______________________________________ Mission Order is issued to Sanitation Inspector who will conduct inspection within 10 days from the receipt of your application for the issuance of Sanitary Permit Inspection reports and sanitary orders issued by Sanitation Inspectors must be acknowledged and signed by the owner/manager Laboratory results (stool & sputum) shall remain valid for three months from the date of application for the issuance of health certificates Official Receipts and results of laboratory tests must be dated within the current year (2016) ONLY those laboratory results and water test analysis from diagnostic/laboratory clinics and water testing laboratory RECOGNIZED by the QCHealth Department shall be accepted. Please see official website for the list of recognized facilities Sanitation Inspectors shall not endorse a particular water testing and diagnostic/clinical laboratory to conduct testing of water and specimens.