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HomeMy WebLinkAboutC10-213 Ambulance Service License WECADEAGLE COUNTY AMBULANCE VEHICLE PERMIT £AGL£ COUNTY PERMIT DATE: From:_ 7/1/2010 To: ,6/30/2011 AMBULANCE SERVICE: Western Eagle County Ambulance District ADDRESS: PO Box 1809 Eagle, CO 81631 PHONE: 970-328-1130 FAX: 970-328-1132 VEHICLE YEAR MAKE TYPE VIN CO-REGISTRATION #1 (801) 2008 Ford E450 1FDXE45P78DA77008 359-REG #2 (802) 2003 Ford E450 1FDXE45F63HA19142 933-HOL #3 (803) 2003 Ford E450 1FDXE45F43HA19141 960-HOL #4 (804) 2003 Ford E450 IFDXE45F73HA60864 861-NBW MEDICAL ADVISOR: Benji Kitagawa, M.D. (Name/Credentials) The inspection of the above named ambulances was made on 6/8/2010 by Anne Robinson, RN .This ambulance service has met permit requirements for Eagle County as established in the resolution as approved b e B and of Commissioners May 2007. INSPECTOR(S): (Signature) ~ ~ (Type Name & Credentials) nne Robinson, RN (Signature) (Type Name & Credentials) PUBLIC HEALTH ADM]NISTRATOR APPROVAL TO ISSUE PERMIT: (Signature) Rachel. Oys `Put~ic Health Director Date:__.~~ 1 " ~ . (~ _ ~~~ EAGLE COUNTY AMBULANCE SERVICE LICENSE ~_ .. EAGLE COUNTY LICENSURE DATE: From: 7/1/2010 To: 6/30/2011 ' AMBULANCE SERVICE: -Western Eagle County Ambulance District ADDRESS: _ PO Box 1809 Eagle, CO 81631 PHONE: 970-328-1130 FAX: 970-328-1132 MEDICAL ADVISOR: Benji Kitagawa, M.D. (Name/Credentials) The inspection of the above named ambulance service was made on _6/10/2010 by -Anne Robinson, RN .This ambulance service has met licensing requirements for Eagle County as established in the re lution as app ed b the Board of Commissioners May 2007. INSPECTOR(S): (Signature) _ (Type Name & Credentials) Anne Robinson, RN (Signature) (Type Name & Credentials) PUBLIC HEALTH DIRECTOR APPROVAL TO ISSUE LICENSE: Rachel Oys, Public Health ire r Date: ~