206 CLEAN MILK 



Receptacles for dung and other refuse. How many?........ 



Kind 



Location 



Condition 



Receptacles for milk. How many? „\ 



Kind 



Condition 



What provision is made for cleaning? 



Is milk cooled immediately after milking? 



If so, how? 



BARNYARD. 



Size long wide 



Is it properly graded? and drained? 



Is it paved? 



What disposition is made of the drainage? 



What is its, condition as to cleanliness at time of inspection?. 



PASTURE. 



Size of 



Condition of 



Is it supplied with drinking water for the cattle? ., 



If so, from what source? 



cattle. 



How many milch cows are usually kept? 



How many other cattle, if any, are kept in the same stable? r . 



Kind of milch cows used 



Condition of cows at time of inspection. General condition 



Cleanliness, etc 



Character of feed 



PRIVY ACCOMMODATIONS. 



How is human excreta from the. premises disposed of? , > 



Location of privy, if any? 



Construction of privy 



Signature of applicant 



Post-office address „ 



To the Health Officer, 



Sir: I have carefully examined the cattle upon the premises above referred? 

 to, and their condition is as follows : 



Signature 



Address. 



Personally appeared before me this day of , 190.., the subscriber, 



who being duly sworn deposes and says that he is a veterinary surgeon, practic- 

 ing in accordance with the laws of the State in which he resides, and that he 

 has personally examined the cattle referred to in the above statement and knows 

 them to be the same as are referred to in the application to which the certificate 

 is appended, and that their condition is correctly described without evasion or 



concealment. 



Signature 



Address * 



