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53
Obverse.
MILKSELLER (OTHER THAN RETAIL PURVEYOR).
Licensed
No. on Reg. Date of Registration distributor of
Address Daily average quantity of milk
Occupier Registered as
Owner Owner's Address
Source of milk supply
Accommodation for Storage. Position
Receptacles Covered
Condition of floor Walls Ceiling
How lighted Ventilated
Method of distribution
Is skimmed milk received
Sanitary Conditions. Drainage Water Closets
Water supply Ablution
Facilities for cleansing
Cistern milk receptacles
Remarks
Date
Inspector
Reverse.
INSPECTIONS.
Date Matters noted Action taken Inspector
Obverse
RETAIL PURVEYOR OF MILK.
Licensed
No. on Reg. Date of Registration distributor of
Address Daily average quantity of milk
Occupier Source of milk supply
Owner Owner's Address
Accommodation for Storage. Position
Receptacles Covered
Condition of floor Walls Ceiling
How lighted Ventilated
Conditions of Retail Sale. Position
Receptacle Position Covered
Other business carried on
Cleanliness of Shop Lighting Ventilation
Method of
Skimmed milk received outside delivery
*
Sanitary Conditions. Drainage Water Closets
Water supply Ablution
Facilities for cleansing
Cistern milk receptacles
Remarks
Date
Inspector
Reverse.