“O‘zstandart” agentligining
2005-yil 30-sentabrdagi
01-1/54, 1-son qarori bilan
TASDIQLANGAN
1-ILOVA
_____________________ DSENM bosh vrachi | |||||||||||||||||||
(hudud nomi) | |||||||||||||||||||
___________________________________ ga | |||||||||||||||||||
(F.I.O.) | |||||||||||||||||||
_____________________________________ (ariza beruvchining F.I.O, | |||||||||||||||||||
_____________________________________ yuridik shaxsning nomi va yuridik manzili | |||||||||||||||||||
_____________________________________ va rahbarining F.I.O.) | |||||||||||||||||||
ARIZA | |||||||||||||||||||
_________________________________(ariza beruvchining nomi) | Sizdan ________________________________________________________(mahsulot ishlab chiqarilgan | ||||||||||||||||||
________________________________________________________________________________________________mamlakatning nomi yoki ishlab chiqarish manzili) | |||||||||||||||||||
________________________________________________________________________________________________(mahsulotning to‘liq nomi, assortimenti va partiyasi) | |||||||||||||||||||
________________________________________________________________________________________ni ishlab chiqarish / sotish uchun sanitariya-epidemiologik xulosa berishingizni so‘rayman (so‘raladi). Ushbu mahsulot(lar) uchun quyidagi hujjatlarni taqdim etamiz: 1. ______________________________________________________________________________________________ 2. ______________________________________________________________________________________________ 3. ______________________________________________________________________________________________ 4. ______________________________________________________________________________________________ 5. ______________________________________________________________________________________________ To‘lovni kafolatlaymiz. Ariza beruvchining rekvizitlari: Bank muassasasi: ____________ O‘/R: _______________________ STIR: _____________________ | |||||||||||||||||||
M.O‘. (muhr mavjud bo‘lganda) | (imzo) | _______________________ (F.I.O.) | |||||||||||||||||
“___” _______________ 20__ y. |
2-ILOVA
O‘zbekiston Respublikasi | ||||
SANITARIYA TEKShIRUVI DALOLATNOMASI | ||||
| ||||
Men ____________________________________________________________________________________________ | ||||
(mas’ul sanitariya vrachi F.I.O) | ||||
Quyidagilar ishtirokida ___________________________________________________________________________ | ||||
(mahsulot egasi | ||||
____________________________________________________________________________________ | ||||
yoki uning vakili F.I.O, lavozimi) | ||||
____________________________________________________________________________________ | ||||
(sanitariya tekshiruvi o‘tkazilgan joy manzili) | ||||
________________________________________________________________________________________________ sanitariya tekshiruvi o‘tkazildi va quyidagilar aniqlandi: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ | ||||
1. _______________________________________________________ | _________________ | |||
(mas’ul sanitariya vrachi F.I.O) | (imzo) | |||
2. _______________________________________________________ |
| |||
(mahsulot egasi yoki uning vakili F.I.O) | (imzo) | |||
(ishlab chiqarish texnik uskunalari sanitariya tekshiruvidan o‘tkazilganda laboratoriya mutaxassisi ishtirok etadi va sanitariya tekshiruvi dalolatnomasini imzolaydi) |
3-ILOVA
MAHSULOTLARDAN NAMUNA OLISh DALOLATNOMASI | ||||||||||
20 ___ yil “___” __________________ | _______________-son | |||||||||
Muassasaning nomi va manzili _______________________________________________________________________________________________________ Namuna olingan vaqt ________________ Laboratoriyaga yetkazilgan vaqt _______________ Etkazish va saqlash sharoitlari ________________________________________________________________________________________________________ Namuna olishdan maqsad _____________________________________________________________________________________________________________ Qo‘shimcha ma’lumotlar ______________________________________________________________________________________________________________ | ||||||||||
Namunaning tartib raqami | Namunalar nomi (turi, navi) | Ishlab chiqaruvchi | Ishlab chiqarilgan sanasi va smenasi | Guruh (partiya) o‘lchami va tartib soni | Namuna og‘irligi va hajmi | Olingan mahsulotning hujjat raqami | Idish va o‘ramning turi | Namuna olishni asoslovchi hujjat | Tahlil maqsadi | Izoh |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
Namuna olgan mas’ul sanitariya vrachi | ||||||||||
______________________________________________(F.I.O., lavozimi) | ________________________ | |||||||||
Namuna olishda ishtirok etgan shaxslar | ||||||||||
______________________________________________(F.I.O., lavozimi) | ________________________ |
3a-ILOVA
LABORATORIYAGA TAQDIM ETILGAN NAMUNALARNI KAYD ETISh JURNALI | |||||||||||
T/r. | Namunalar nomi (turi, navi) | Ishlab chiqaruvchi | Ishlab chiqarilgan sanasi va smenasi | Guruh (partiya) o‘lchami va tartib soni | Olingan namunalarning miqdori | Namuna olingan hujjat raqami | Idish va o‘ramning turi | Namuna olishni asoslovchi hujjat | Tahlil maqsadi | Izoh | |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | ||
4-ILOVA
“TASDIQLAYMAN” | |||
(laboratoriya mudiri yoki tegishli mas’ul shaxsning F.I.O.) | |||
20___ “___” ________________ | |||
| |||
20__ yil “____” _________________ | |||
Laboratoriya nomi _________________________________________________________________________________ | |||
(akkreditatsiya guvohnomasining raqami, | |||
____________________________________________________________________________________ | |||
manzili, telefoni, faksi) | |||
Ariza beruvchining nomi ___________________________________________________________________________ Ishlab chiqaruvchining nomi _________________________________________________________________________ Markalash ma’lumotlari ___________________________________________________________________________ ________________________________________________________________________________________________ Tekshiruv obyekti uchun normativ hujjat ______________________________________________________________ Tahlil usullari uchun normativ hujjat ________________________________________________________________ Tahlil o‘tkazish sharoitlari _________________________________________________________________________ | |||
(harorat, namlik va boshqa sharoitlar) | |||
Tekshiruv o‘tkazishga jalb qilingan shaxs _______________________________________________________________ ________________________________________________________________________________________________ | |||
Tahlillar o‘tkazish natijalari | |||
Ko‘rsatkichlarning nomi | Ko‘rsatkichlarning ahamiyati | Ko‘rsatkichlarning mosligi | |
Normativ hujjat bo‘yicha | Amaldagi | ||
| |||
|
|
| |
(laboratoriya mutaxassisi F.I.O) | (imzo) | (sana) | |
_______________________________________(laboratoriya mudiri F.I.O) | ____________________ | ____________________ |
5-ILOVA
O‘ZBEKISTON RESPUBLIKASI SOG‘LIQNI SAQLASh VAZIRLIGI | ||
| ||
(sanitariya-epidemiologik xulosasini beruvchi muassasaning nomi) | ||
| ||
20__yil “___” ______________dan | ______________ gacha haqiqiy hisoblanadi. | |
_________________________________________________________________________________________________ Ushbu xulosa bilan: _________________________________________________________________________________ | ||
(ishlab chiqaruvchi, kelib chiqish davlati, olib keluvchi) | ||
_________________________________________________________________________________________________ | ||
Ishlab chiqarilgan (olib kelingan) mahsulot: ____________________________________________________________ | ||
(mahsulot nomi, miqdori) | ||
__________________________________________________________________________________________________________________________________________________________________________________________________(o‘tkazilgan laboratoriya tekshiruvlari bayonnomalari, natijalari) | ||
SANITARIYA NORMALARI. QOIDALARI VA GIGIYENA NORMATIVLARIGA JAVOB BERADI. | ||
Xulosa oluvchi: ____________________________________________________________________________________ | ||
M.O‘. | 20 __ yil “___” _______________ |