Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
bocc.con.017.1994
1�- ~ +y < ml 1 : . i c . ,��CPa�4i �q - � �... � � ,.!, 1 .. .. �.:� , . tR ` � p •�„ �r� �� .. ) �'� • ,�i;. � �'��� s . tt }J �.l C f� �" � �"� :.�� �-� .. f> ,. v, r,F�.?„F,t ,Rty*A'' �- � . '� "� �� , • � �' -�;�' _ �t 10L.' �`� � ��1t k � . KA�t ._�' `' � a � . ..:� ,:'....�r.x. .�, x' .�3s�.a`.-: ,�j� � C�� p�y '� � � , GRANT OF LICENSE/PERMIT ' � The undersigned, representing the Board of County Commissioners 4, ot Pitkin County, Colorado, does hereby grant a license to the � above named applicant to provide ambulance service within Pitkin County. This license shall have upon it any restrictions listed ,� below, shall be granted any waivers Zisted beZow, and shall be valid for the dates listed below, unless revoked by the Board pursuant to the provisions of Resolution No,. .87-9 ',� RESTRICTIONS: y . 6 WAIVERS GRANTED: ___ = .y ; ! THIS LICENSE IS VALID FROM/UNTIL: January 1, 1994 until December 31. 1994. i " I � � � ` � DATE: i' /�G7-c��^//( ��//�'� j CHAIRMAN, SOARD OF COUNTY COMMISSIONERS j / I .__,.., .___...__ .,:...,, •- . . ... ,.. {,��."cS._. � { ( f�x.+?fi�- . . - . . . � �. � .. � . . . �.. � �. . . �� . . � � � �� .�- � , '��'':rfi .. .� . . �. . . .. . .. .. � . ' . :q�. � � ��,, ; _. ^ 1 t „ ,;y ; . r „ . ,. , ; :, f4t} VJ�P . . - :. i �.'- rc • ' .5�+.�gi� � �e p�� �"�'f.�y'S� 7 , - r .. . . :� � . . . t.�1,1..- rv �u`��'� '4k,i.'�'r Y' �'° . ��t�� ,� �. ...,niE.yA'y •'�� ������ �# r '��. �,r�t . :� r.� y�rt .a} ��� i i p�l's =�i�', ��r1�a�,k� � � .HN.A...r�. ��. .,I.� allJh. - • � I ,� I . �'•l�nl� S � � . 1. S A4 J �t . PITKIN COUNTY APPLICA4'ION P'OR AMHULItNCE LICEN5� � H :� . 5 PLGASE TYPE ALL IN�ORMATION SERVICG NAM�: ��cti,,( �-v��,�l�\�.t�t. =ntSt»acY- (�Sjv�l_ �n�� ac� , 1_ . y, :" ADDRCSS: n�}.o� ^'>c c C��cE.�t l�� n.c�Gn� � � OWN�R5 OR OFFIC�RS: : � � PFICTTE NUMBERS: �2,s- ►1 z.o �r� D�SCRIPTION OL•' AMBULANCE: MAKi�, MODCL', YEAR, LICENSE NO. . � ��as �-OR� VAA1 — �IMrE, 1�. ,�CcaJNr�l �•• � f=D�-1--� 1y-l_s Fl1A Z.SLS� . � ADDR�5S AND D�SCRIPTION OP IIAS� OF OP�RATIONS_ " �0���ry oo�•� � � f�'S L� V Au.c_.� 4!1��:.�,,-,.�._ -'� � _ � PHYSICIAN ADVISOR: �i: �A�,1,-� M�AI�t .� J COLORADO CERTIFICATION NUM$ER: {3 3 c3 3 C_r�,_o � PHONC NUM$�RS: Z � SIGNATUR�: („� — . --'-`� WAIVER REQU�STS: � o�� � ~'. �+ • j � I �. . f �� '� APPLICANT: Ztt,�4��ti.-o a.l _ �.�n��c.��.. DATE: �llt�q; (�; f::�'t j � SIGNATURE:��� �G! C...l u� �- y � � ! i; � Y � a ' � -t f - , t. .; , � . . ���� . ::�.,;.. ' .. "_':'_. -y�;. . . � . .. ,�a.: ' .P 'yh. �•5. � . .. ..�. . . . .. . . ._. ." � � �.r,^�..��,<��..�.,.. . . .�.. :.::...��..,i ��.-. � _ii� � - ' Y ' . � . .. ... -. _ . . � i _ . . . . ' . � . . . � �'.. -.. ... .�. . . . . '. ... .` . � . . . . . .. . � - . ' . . :•�- � ..� .. � . . : . . .� � . . . . . / . - � . - . . . . .. . � f . ..�� . . . . . � . . . .. . . ... . . ��'1� " . . . . . � � . ?l� , > �;J� : t,;tE ` r, r � . . f , ,;� � F f tn,�yt � � v '� �, }� k kJ , . �✓.� . �;: � . .. , u . . �7' � �.�1.'"7'��r.� ,. . i . . r ��; '� ,� � �.� . As��^ C'��x .h t,��-�. ,`�.'t�'�� ,.. . ��k��:���'� � � �� x �� �,. _ �,��� . ,_ _ ��<€u�� .. _ ,..-wa!r«��+e.� . . ' � . . . - ' . , ' . . ���.. . , . ,...__ . . .,._..__._�__._.. Fi. , . . , _.. ..___--- --. .:; .... ......... .. . .. �:�. , ,. . . � M c_..o,c 5 • ---__., :<; , ��; �'tia ,f;� 7 ;�� PITKIN COUNTY AMBULANCE INSPECTION LIST a x .� � �� Service Name: , --------------Q--------------------------------- y � Vehicle Designationc__Qi..RrX���S__________ , 4 �icense Plate- C�G�O�j NCIC CCIC ' �" -------------------------- --- --- Tnspected BY'--------��--�h�--------------° Aate: ------------ .' � ',�� � Inspector's Signatur-e, iF passed=______�_�_�r.s�____________ .� � --------------------------------------------------------------- . ITEt1 YES NO Cw�renl: Vehicle Registration _✓ ____ Proof oP Insurance � A11 vehicle lighCs worl<inq _ _✓ ___� All emergency lights working _� ____ Secure stora9e of equipment _� ____ Portable suction apparatus wiL-h wide-bore -- .� tubing and pharyngeal suction tip _�L- ____ [f' 8ag-valve-mask with adult, child, and infant masks_ � Must have reservoir capabilitv ____ uropharyngeal airways_ aduit,�child� 'n..� fan�.�izes � ____ _L---'. � . �__. Nasopharyngeal airways�adult, child,'inPant� ____ �__-��_.-- � � Portable axygen system includingc Lanl< & regulaCor ___ , _:. ' /' . �.. : . \/ adult child, i�itfan valveless masks ____ ____ �, t ; , , . �'"'-----� _ ''/ - ,, , , " ' '' ` ^ nasal cannul� y '- - -- ---- --... .. ....--- , / Two clean burn sheets _ V _ Triangular bandages with safet-y pins ' _V_ ___ � : i " ---�-- ---__.. _..,.....�. ....--- -- '�' - -- - . ' .. ---- - - -- •• ,t� � ; a : � , ` .. � � . ryT��: " - �.:"T , • 4Ta ,�.�r _..___........_.__.,.�_,�_____ ._,..._ i. ..„_, .�._..._.. , ___.. +1� ��._y , i. ;: f� ��...3 � r! V .. � �� 4aItN1s'�. ' -� ' , /. �f :i' ��,�>r +S �'y}�" ��� ��B -� ��f.K4a'S 1 e1r.�;: .. , m(:�,lti �.ra ,i�t ,�i�'� +"'� c � trE �. ,� , .� - �:�` :�.. . � . � � .' � R�a ry5�-j .. � i' , , � 1�� it� � _ ..<�'�' s 'Ad� .. cw t . . . . . :, �,,, Lk: _ .:.,:. , � ' "__'�-1ic�--'-----'�:. � ...._..__. �_ � � � . . :,'_j ,.„ . ' . .. . .�,;,i . . � � Lower extremity traction splint _� ____ � ExtremiL•y iminobilizing device � � .� t�on9 sPine board '✓ ---- � Short spine board �br equivalent _v ____ ; � Sterile obstetrical I<it _J,�____ 4 �b�-- ---- - Two-way hospital radio system One adttlt B/P cuff _� ____ One child B/P cuff _� _ 7wo stethoscopes � Sterile irrigation solution _�� ____ Roll of aluminum foil or space blanlcet � � Shears or heavy scissors � ____ Two flash.lights ! \ / -� -_-- ._ � r � ----�.�� i One 10lE or two SiE fire exL-inguishers � ____ Une pocitet mask '�f ____ Vehicle oxygen system capable of delivering / -:. ✓ 10 liters for a0 minutes = ?00 liters ___ ____ __..._ � .< . - � Une scoop stretcher (�����j����(� �j.. � :�' ---- ---- Une each: large, medium, small, C-collar _�� __ Une alLernate system fnr cervical irnmobilization such as= sand bags, IV bags, foam pads _V_ _ Two bite sticks _✓ ____ Emesis basin(s) with one quart capacity � ___ ;3 Three blankets V _ ____ Four each large and small universal dressi�gs (�_/'_�__ 24 9auze pads (Ax4) 'V_ ---- One universal urinal _�____ � ,: . ,.._., ,_ .__:. . ----__. :...._ __ i_.- -- -:- - .,."s`�t�;-:. , _. . _�. , ,-.; :,. . : � : , . . . ... . :_ '� `- � . . . �. - � : � ' , �:... , . .. . . . .. ... . ._.. 1. . ���� , , . �?', � �p� .� .-f � � . �f� ..fi j �7 _�� 'i �� 1 :.� "'tn '1` �° , ..�- . 57 � !^ � �s., j�,� � � .. � �, � .� ,. ,Ar �t � �� � � q:� r rJ: r u+ . ..• ,+"da � =+'7^.'�1`�s �6� � '��,'R.SI�. 4 i� L+�,r.�R :����. . .. . . ;� '� . � i ���]'[� . . .. _ y� ..°�, �t`� ��,!„I.I}��{'.r.:!v-F. .�r t ��e� �� . �,:�: ,.�._..._....v_ ....... . .. . . �{`�. � , ) q /� . d � � � � . . . . / � . � 4 soFt roller bandages, 4 inc!-i _ V ____ Two ace bandages, 4 znch _� ____ ' ' � f•�=--'�- "- � / Two ea h•¢ �2 inch an� 1 inch adhesive tape P/ � ��-� 1 l ---- � 4 vaseline gauze pads ��!_ ____ � Two tubes of glucose � _ : y : � ✓ - -- ` s Two 30cc bottles Syrup of Ipecac ____ � Une SOc� bottle oF charcoal � __ _ r;�:+ Une pair oF M_A_S_T_(pneumatic anti-shoclt garment) _� ____ ' I i . ' � . � Requested Waivers of Countv ��equired equipment, From applicationc : . . .�...1: � ------------------------------------^---------------------------- � � � � � . �.:,._,� . . . . � � � ��� -.:� . � ----'-----------------`-----------"----^--------------------------- . . . . . . . : .`� .� �--------------'-------------------------------------------------- - . . ---------------------------------^------------------------------ � � . .. . . ,_ � ----------^------------------------------------------------------ . � � - -----�----^----------------"-------------"----------------------- - , . . - .h .. . � � . . '�-.��. . .J . . . �.;�. S� . _____`._____-�_____________�__�^___�_,______.__�__-_^__-__�,_____ .,. , - . ___,___^_`.�____-�^__�_-_�_______________________�________________ {. . . ._ .�"� . _ . . . .. . �;. � . / � , E . . � . ...R.� � � . . � . �. . . . . �. . . . . � . . � . � , f� , . . .,..�.;r�..� :,�..,>._ -..:...... -:::..: .,:.._. .. . : . . ..._ . __._.. ..._'.-.... __..__ _. �.. �_.. .. - � .... �, "��'"� ,, - . ,.__ : . . , . ., fi � � . � . .. � . � 'I 1 � .. � , � . . .. . . � . . .. i . . � .. . . .. . . /'. . ' ... . . . .. .. . ... . " ./ ., ,. �� � . . - . . . .. . . . � . -. • bF`'"*� . y�y ,� ..