MILK INSPECTION 



215 



.Pt 



Health Department of. 



Specimen No 



Purchased as 



Collection of samples — Inspector's memorandum and label* 



Health Department of 



No igo. . 



Milk "j 

 Crearr. J 



Name of vendor 



Address 



Business 



Taken from 



Served by 



No. card. Amount 



Inspector Inspector. 



Time of purchase. 



Health Department of. 



report of analysis. 



Substances offered for sale or sold as 

 Milk Cream Skimmed milk 



by 



at on 



., 190. 



Analysis. 



Remarks . 



.Analyst. 



* Form used in District of Columbia. 



