According to the Paperworit Reduction Act of 1995, no persons are required to respond to a collection of Inlomiatlon unless it displays a valid 0MB control number. The valid OUB 

 control number (orlnis intormation collection is 0579-0084. The lime required to complete this (niormalion colleciion is estimated to average 1.5 hours per response, mcluding the 

 time tor reviewing instructions, search existing data sources, gathenng and maintaining the data needed, and completing and revewmg trie collection ot intonnalion. 



FORM APPROVED - 

 0MB NO. 0579-0084 



U.S. DEPARTMENT OF AGRICULTURE 



ANIMAL AND PLANT HEALTH INSPECTION SERVICE 



VETERINARY SERVICES 



TUBERCULOSIS INFECTED HERD 



G BOVINE D CERVINE D 5TRi^ 



INSTRUCTIONS: Prepare at the time of 

 identification of reactors, and attach to VS 

 Form 6-22, Tuberculosis Test Record. 



NAME OF OWNER OF INFECTED HERD 



FARM NO. ADDRESS OF OWNER 



OFFICE USE 



COUNTY 



OWNER CLASS (Check one) 



1 FARMER 



2 DEALER 



3 STOCKYARD 



4 SALES RING 



DATE TEST READ (Month, day. 

 year) 



SECTION 1 - OTHER ANIMALS ON FARM (Inventroy; use continuation sheet If needed) 



LIST SPECIES 



CONTACT 



NUMBER 



NECOPSIED 



(Specify e.g. swine, poultry, cervid. llama. 



REACTOR 



ON THE 

 FARM 



TESTED 



REACTED 



NUMBER 



NO. WITH 



antelope, etc.) 



YES 



NO 



TB 



































VS FORM 6-22A 

 (FEB 99) 





SECTION II 



- IDENTIFICATION AND HISTORY OF REACTORS FOUND ON THIS TEST 











IDENTinCATION 



REACTOR TAG 



AGE 



BREED 



SEX 



ORIGIN OF REACTOR 



DESCRIPTION (Registration No., 

 color, markings, etc.) 



LESION 

 CODE 



LAB 



TAG OR TATTOO 



1 nusEO 



OH FAUU 





3 PURCWAStO 

 UNKNOWN 

 SOURCE 



SULTS 

















2 ORIGIN 

 UNKNOWN 





4 PunCHASEO 

 KNOWN 

 SOURCE 





' PURCHASE FROM 







ADDRESS 



OWNER CLASS (Purchased from) 



DATE 







1 FARMER 





3 STOCK- 

 YARD 



PURCHASED 





MONTH 



YEAR 





!2 DEALER 





4. SALES 



RING 







IDENTIRCATION 



REACTOR TAG 



AGE 



BREED 



SEX 



ORIGIN OF REACTOR 



DESCRIPTION (Registration No.. 

 color, markings, etc.) 



LESION 

 CODE 



LAB 

 RE- 

 SULTS 



TAG OR TATTOO 









1 RMSED 

 ON FARM 





1 PURCHASED 

 UNKNOWN 

 SOURCE 











2 ORIGIN 

 UNKNOWN 





4 PURCHASED 

 KNOWN 

 SOURCE 





^ PURCHASE FROM 







ADDRESS 



OWNER CLASS (Purchased from) 



DATE 

 PURCHASED 







1 FARMER 





3 STOCK- 

 YARD 





MONTH 



YEAR 







2 DEALER 





4. SALES 



RING 







IDENTIFICATION 



REACTOR TAG 



AGE [BREED 



SEX 



ORIGIN OF REACTOR 



DESCRIPTION (Registration No., 

 color, markings, etc.) 



LESION 

 CODE 



LAB 



TAG OR TATTOO 









1 RMS£0 

 ONFARU 





) PURCHASED 

 UNKNOWN 

 SOURCE 



SULTS 













2 ORISIN 

 UNKNOWN 



< PURCHASED 

 KNOWN 

 SOURCE 





^ PURCHASE FROM 







ADDRESS 



OWNER CLASS (Purchased from) 



DATE 

 PURCHASED 





1 FARMER 





3 STOCK- 

 YARD 





MONTH 



YEAR 





2 DEALER 





4. SALES 

 RING 







IDENTIFICATION 



REACTOR TAG 



AGE 



BREED 



SEX 



ORIGIN OF REACTOR 



DESCRIPTION (Registration No . 

 color, markings, etc.) 



LESION 

 CODE 



LAB 

 RE- 



TAG OR TATTOO 





1 RAISED 

 ON FARM 





3 PURCHASED 

 UNKNOWN 

 SOURCE 



SULTS 













2 ORIGIN 

 UNKNOWN 





4 PURCHASED 

 KNOWN 

 SOURCE 





'* PURCHASE FROM 





ADDRESS 



OWNER CLASS (Purchased from) 



DATE 

 PURCHASED 







1 FARMER 





3 STOCK- 

 YARD 





MONTH 



YEAR 







2 DEALER 





4. SALtS 

 RING 







IDENTIFICATION 



REACTOR TAG 



AGE 



BREED 



SEX 



ORIGIN OF REACTOR 



DESCRIPTION (Registration No., 

 color, markings, etc.) 



LESION 

 CODE 



LAB 



TAG OR TATTOO 





1 RAISED 

 ON FARM 





1 PURCHASED 

 UNKNOWN 

 SOURCE 



SULTS 













2 ORIGIN 

 UNKNOWN 





4 PURCHASED 

 KNOWN 

 SOURCE 





' PURCHASE FROM 







ADDRESS 



OWNER CLASS (Purchased from) 



DATE 

 PURCHASED 







1 FARMER 





3 STOCK- 

 YARD 





MONTH 



YEAR 



















2 DEALER 





4. bALtb 

 RING 







(Previous editions are obsolete.) 



(Over) 



16-18 



