microbiological methods check list（微生物方法检查表）.docVIP

ELAP-MAIN OFFICE ELAP – LOS ANGELES FIELD OFFICE ELAP – SACRAMENTO OFFICE DEPARTMENT OF HEALTH SERVICES DEPARTMENT OF HEALTH SERVICES DEPARTMENT OF HEALTH SERVICES 1625 SHATTUCK AVENUE, RM. 101 1449 WEST TEMPLE STREET, RM 231 601 NORTH SEVENTH, MS 92 BERKELEY, CA 94709-1611 LOS ANGELES, CA 90026-5698 PO BOX 942732 TEL (510) 540-2800 TEL (213) 580-5731 SACRAMENTO, CA 94234 FAX (510) 849-5106 FAX (213) 580-5706 TEL (916) 323-4767 ____________________________________________________________________________________________________________________ ENVIRONMENTAL LABORATORY ACCREDITATION PROGRAM CHECKLIST FOR LABORATORY ON-SITE INSPECTION LABORATORY INFORMATION Laboratory Name ____________________________________________________________________________ ELAP Reference No ___________________ Certificate No __________________ Expiration Date ____________ Telephone No ____________________________________ FAX No ___________________________________ Laboratory Director __________________________________________________________________________ Contact Person and Title ______________________________________________________________________ DEPARTMENT INFORMATION Inspector Name _____________________________________________________________________________ Signature of Inspector _______________________________________________ Date ____________________ Inspection Type: ( ) Pre-certification Inspection ( ) Initial Certification Inspection ( ) Renewal Certification Inspection ( ) Post-Certification Inspection ( ) Follow-up Inspection ( ) Other (specify) ________________________________________ LABORATORY CONFIRMATION OF INSPECTION This is to confirm that an on-site inspection was conducted on this date at the laboratory. Signature does not necessarily constitute agreement with the findings of the inspector. ________________________________________________________________ ________________________ Signature o