VS Form 4-54: Brucellosis Test Record: Market Cattle Testing Program 



STATE 



Enter the name of the State. 



SAMPLES DRAWN AT 



Mark the appropriate box. 



ESTAB. NUMBER 



Enter the unique number assigned to each establish- 

 ment (slaughterhouse or livestock market). You may 

 obtain these numbers from the Veterinary Services area 

 office in your State. 



NAME AND ADDRESS OF PLACE WHERE SAMPLES 

 WERE DRAWN 



Enter the complete name and mailing address. 



CERTIFICATION 



Sign the form and enter the date that the samples 

 were drawn. 



TESTING LABORATORY 



If the blood samples are being sent to a laboratory, leave 

 this block blank; the laboratory will fill it in. If you are 

 collecting the samples at a market and conducting the 

 tests yourself, fill in the information. Enter the name of 

 the laboratory and the address where you are actually 

 conducting the tests. 



TEST RESULTS 



If the samples are sent to a laboratory, leave this area 

 blank. If you are conducting the tests, enter the results. 



TUBE NO. 



Self-explanatory. 



SALES TAG OR BRAND 



Self-explanatory. 



BACK TAG NUMBER 



Self-explanatory. 



EARTAG NUMBER 



Self-explanatory. 



VACC. TATTOO 



1 ist the vaccination tattoo, if present. 



AGE 



Hntcr the age in years or months. Indicate which you 

 are using by placing an M or \' after the number. 



BREED 



Enter the proper breed code. 



SEX 



Enter M or F. 



COUNTY 



List the count\' of origin of the cattle. If unknown, 

 leave blank. 



HERD OWNER'S NAME 



Self-explanatory. 



ADDRESS 



Enter the address of the herd owner. 



16-14 



