MILK INSPECTION 



209 



SANITARY INSPECTION OF DAIRIES. 



Owner or lessee of farm 



Town State 



Total No. of cows No. milking Quarts of milk produced daily 



Is product sold at wholesale or retail ? 



If shipped to dealer give name and address 



Permit No Date of inspection > t g 



Score. 



Total score. 



Sanitary conditions are — Excellent Good Fair. 



Suggestions by inspector 



Signed 



Poor. 



Inspector. 



