VS 4-39 Brucellosis Ring Test Patron List

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0047. The time required to complete this information collection is estimated to average .025 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved 0579-0047

UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES BRUCELLOSIS RING TEST PATRON LIST

PLANT NAME

PLANT ADDRESS

PLANT NUMBER

MILK A B

CREAM

DATE

PATRON NUMBER

OWNER’S NAME

ADDRESS

COUNTY

LOCATION

HERD NUMBER

TEST RE- SULT

CO.

TWP.

SEC.

MILK

NEGATIVE

SUSPICIOUS

UNSATIS- FACTORY

OTHER

TOTAL

COLLECTED BY

COLLECTION DATE

TEST RESULTS N – negative S – suspicious U – unsatisfactory O – other D – discontinued

CREAM

SUPERVISOR OF LABORATORY

TEST DATE

VS FORM 4-39

APR 2009

Form Copy Designation

Part 1-OFFICE

Part 2-livestock inspector

Part 3-State office

Part 4-plant