ACTA DE INSPECCION

Siendo las_______ horas del da ___ de ____________ del ao _____ en el

establecimiento __________________________________________________, distrito de
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Provincia de ________________ y departamento de Lima, con motivo de la
inspeccin efectuada
Por ______________________ con D.N.I. N ___________
de la Micro red
Hualmay atendido por _______________________________ con D.N.I. N
_________________ quien no permiti el ingreso, constndose lo siguiente:
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Para mayor constancia se firma la presente Acta, en seal de conformidad,

siendo las ___________
Horas del _____ de _______________ del 2014

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Nombre y Apellido_________________
Apellido______________

Nombre y