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Form for Voluntary Surrender
of Meat, Fish or other Articles
of Food.
COUNTY BOROUGH OF WEST HAM.
particulars of foods, etc.,
surrendered.
Date 182
Time
Article Examined
Where Examined
Result of Examination
Name and Address of Owner
Surrendered by
Destroyed at
Remarks
San'tary Inspector's Initials
Form for Voluntary Surrender
of Meat, Fish or other Articles
of Food.
COUNTY BOROUGH OF WEST HAM.
(public health department).
Public Health Act, 1875.
Meat Regulations, 1924.
THIS IS TO CERTIFY
that Mr
has this day Voluntarily surrendered to
me, the undersigned
which upon Examination (was) (were)
lound to be
and unfit for the food of man.
Signed,
Sanitary Inspector.
Date 192
Form for Voluntary Surrender
of Meat, Fish or other Articles
of Food.
COUNTY BOROUOH OF WESI HAM.
(public health department).
Public Health Act, 1875, and Sect. 28.
Public Health Acts Amentment Act, 1890.
Meat Regulations, 1924.
THIS IS TO CERTIFY that I, the
undersigned, being THE OWNER of
which upon Examination by Mr
Sanitary Inspector to
the Sanitary Authority (are) (is) declared
by him to be
and unfit for the food of man, do hereby
Voluntarily Surrender the said
for the purpose of
having the same destroyed or so disposed
of as to prevent (it) (them) being used
for the food of man.
Signed
Date 192