Modelo de Acta de Supervisión
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Transcript of Modelo de Acta de Supervisión
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7/25/2019 Modelo de Acta de Supervisin
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MUNICIPALIDADDISTRITAL DE PAIJAN
ACTA DESUPERVISIN
N
INFORMACIN DEL ADMINISTRADO
TITULAR Y/O
RAZN SOCIAL
DIRECCIN
DISTRITO PAIJANPROVINCIA
ASCOPE
REGION LA LIBERTAD
ACTIVIDAD(marcar con X)
COERCIALIZACIN ( ) PRODUCTIVA ( )
SERVICIOS ( ) OTROS!
TIPO DE
DOCUENTO RUC ( ) DNI ( )
DATOS DE LA SUPERVISIN
TIPO DESUPERVISIN
DE O"ICIO ( )"EC#A DESUPERVISIN
INICIO
DE PARTE ( ) CIERRE
$REARESPONSABLE DELA SUPERVISIN
SUPERVISOR CARGO DNI
SUPERVISIN AMBIENTAL
SUPERVISA
#UOS ( ) RUIDO ( ) ATERIALPARTICULADO
( )
GASES ( )RESIDUOSSLIDOSUNICIPALES
( )
RESIDUOS DE LASACTIVIDADES DECONSTRUCCIN YDEOLICIN
( )
VERTIIENTOS ( )OTROS !
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MUNICIPALIDADDISTRITAL DE PAIJAN
ACTA DESUPERVISIN
N
HECHOS VERIFICADOS
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ACUERDOS / RECOMENDACIONES
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SUBSANACIN
(DE SER EL CASO)
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MUNICIPALIDADDISTRITAL DE PAIJAN
ACTA DESUPERVISIN
N
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PRXIMA ACCIN
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SUPERVISOR ADMINISTRADO
NOBRE! NOBRE!
DNI! DNI!
