C NG HÒA XÃ H I CH NGHĨA VI T NAMỘ Ộ Ủ Ệ
Đ c l p - T do - H nh phúcộ ậ ự ạ
B N DI N GIÃI ĐI U KI N C S HÀNH NGHẢ Ễ Ề Ệ Ơ Ơ Ề
Thu c lĩnh v cộ ự :............................................................................
I. C s hành ngh :ơ ở ề
1. Tôi tên là:..............................................................................................................
Đ i di n c s hành ngh ạ ệ ơ ở ề (tên cơ
s )ở:.....................................................................
Lo i hình hành ngh đăng ký:................................................................................ạ ề
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T i đ a đi m:.........................................................................................................ạ ị ể
S h u c s hành nghở ữ ơ ở ề
c a:...................................................................................ủ
(N u không thu c s h u c a ng i đăng ký thì ph i có h p đ ng th aế ộ ở ữ ủ ườ ả ợ ồ ỏ
thu n thuê, m n...có xác nh n c a chính quy n đ a ph ng)ậ ướ ậ ủ ề ị ươ
2. Đi u ki n c s :ề ệ ơ ở
- T ng s phòng:...............ổ ố (Ghi c th t ng lo i phòng thu c m i lĩnh v c ho tụ ể ừ ạ ộ ỗ ự ạ
đ ng, g m:di n tích, các ph ng ti n chính ph c v ho t đ ng m i phòngộ ồ ệ ươ ệ ụ ụ ạ ộ ỗ ),
g m có:ồ
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3. Đi u ki n đ m b o v sinh môi tr ng:ề ệ ả ả ệ ườ
* Ph ng ti n tri t khu n Y d ngươ ệ ệ ẩ ụ
c :.....................................................................ụ
* Đi u ki n ánh sáng:............................................................................................ề ệ
* Đi u ki n thoáng khí:..........................................................................................ề ệ
* Ngu n n c cung c p:........................................................................................ồ ướ ấ
* Ph ng pháp x lý ch t th i Yươ ử ấ ả
t :......................................................................ế
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II. Trang thi t b , hóa ch t, d ng c ph c v lĩnh v c đăng ký hành nghế ị ấ ụ ụ ụ ụ ự ề (
ghi c th t ng danh m c, quy cách, s l ng , ch t l ng) .ụ ể ừ ụ ố ượ ấ ượ
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III. Nhân l c:ự(ghi H và tên, trình đ chuyên môn, lĩnh v c tham gia ho t đ ngọ ộ ự ạ ộ
m i ng i).ỗ ườ
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.......... Ngày....tháng.....năm...........
Ng i khaiườ
( Ký và ghi rõ h tên )ọ