现场检查记录(首页)

第    页共   页

被检查人：                                                

检查场所：                                                

住址（地址）：                                           

营业执照编号：            粮食收购许可证号：               

法定代表人（负责人）：       联系电话：                  

检查时间：    年    月     日     时  分至   时     分

检查人员：                         记录人：              

我们是                   粮食局的执法人员（姓名）         ，执法证件编号：       现就                              的有关情况进行现场检查，请予配合。

检查过程及有关情况：                                                                         

注：被检查人应在每页检查笔录和修改处签字、盖章或摁指印。

现场检查记录(末页)

第   页共    页                                                                                                                                                                                               

被检查人对检查的意见：                                                                                                                            

被检查人（签字或盖章）：                                                                                                                       

检查人：                                                                                                                           

记录人：                                                                                                                          

见证人：                                                                                                                         

                                        年   月   日               

注：该文书为相关执法文书的末页。