Fillable Tanning Facility Information Form (Island Health)

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Tanning Facility Information Form (Island Health)

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Country of origin: CANADA
File type: PDF

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2011/11/22
FACILITY
INFORMATION
FACILITY NAME □CHAIN
FACILITY LOCATION ADDRESS □FRANCHISE
CITY POSTAL CODE □
FACILITY MAILING ADDRESS □SAME AS FACILITY OR
TELEPHONE FAX
E-MAIL WEBSITE
OPERATOR NAME
FACILITY’S
REGISTERED
OWNER(S)
REGISTERED OWNER NAME □SOLE PROPRIETOR
MAILING ADDRESS □PARTNERSHIP
CITY POSTAL CODE □INCORPORATED
TELEPHONE FAX □
E-MAIL WEBSITE
BUILDING
INFORMATION
□BUILDING/PROPERTY ADDRESS INFORMATION SAME AS FACILITY ADDRESS
□BUILDING OWNER INFORMATION SAME AS FACILITY OWNER
BUILDING OR
COMPLEX
IS THE FACILITY PART OF A MALL? □IF SO, MALL NAME
BUILDING NAME (IF DIFFERENT FROM FACIILTY)
ADDRESS CITY POSTAL CODE
OWNER OF
BUILDING OR
COMPLEX
REGISTERED NAME □SOLE PROPRIETOR
MAILING ADDRESS □PARTNERSHIP
CITY PROVINCE POSTAL CODE □INCORPORATED
TELEPHONE FAX □
E-MAIL WEBSITE
EQUIPMENT
INFORMATION
[INDICATE ANY LEASED
EQUIPMENT WITH AN
ASTERISK (*)]
MODEL
SERIAL NUMBER
MANUFACTURE
DATE
MANUFACTURER ADDRESS
NOTES
SIGNATURE
SIGNATURE DATE
PRINT NAME
TANNING FACILITY INFORMATION FORM
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Tanning Facility Information Form (Island Health)

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Completed 16 July 2020

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