* * The health supervisors of * * * and * * * of the Municipal Health Bureau neatly wear health supervision clothes, show their law enforcement certificates (ID numbers: * * * * * *, * * * *), and carry out health supervision and inspection on the unit accompanied by the person in charge of the reform unit. The inspection found that:

1、********

2、********

3. * * * * * (You can specify the behavior or environment in which nonconformities are found)

The above transcript is true. (This sentence is required)

Signature of inspected person: signature of health supervisor: (at least two signatures are required for law enforcement)

Year, month, sun, moon, sun.