799 
DESCEIPTION OF PREMISES. 
Construction of building 
[Brick. 
Number and location of rooms used for dairy purposes 
Ventilation and light. Number of windows ; doors 
Floor : Wood, concrete, brick, brick and concrete 
How is the floor drained? 
State location of water-closets, privies, and urinals on the premises 
Are premises used for any purpose other than the sale of dairy products? If 
so, what? 
{ Steam, 
Hot. 
Cold. 
Describe facilities for cleaning cans, bottles, and utensils 
Describe facilities for storing 
How is milk cooled? 
Is the dairj' screened as required by law? 
plilk. 
Gallons sold daily J Cream. 
[Buttermilk. 
Number of receptacles used ; kind 
Number of wagons 
List of shippers 
If business is to be operated under a trade name, please state such name. 
Kespectfully, 
Name- 
Address. 
Acknowledgment of Receipt of Applications. 
Commissioners of the District of Columbia, 
Health Department, 
Dairy and Dairi: Farm Inspection Service, 
Washington, D. C., , 19--. 
This department is in receipt of your application for 
{ conduct a dairy in I 
conduct a dairy farm in Ithe District of Columbia. 
bring or send milk and cream into J 
Having filed the said application you may now lawfully begin business and 
continue the same until flnal action has been taken upon your application. An 
inspection of your establishment will be made at an early date. 
Respectfully, 
M. D., 
Health Officer. 
Please preserve this card as evidence of your authority to engage in the above business. 
