+--------------+-------+-----------------------+-----------------------+
| **DEPARTMENT |       | **DAIRY FARM          | INSPECTING AGENCY     |
| OF HEALTH    |       | INSPECTION REPORT**   |                       |
| AND HUMAN    |       |                       |                       |
| SERVICES**\  |       |                       |                       |
| FOOD AND     |       |                       |                       |
| DRUG         |       |                       |                       |
| AD           |       |                       |                       |
| MINISTRATION |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
| NAME AND     |       |                       | Pounds Sold Daily     |
| LOCATION OF  |       |                       |                       |
| DAIRY FARM   |       |                       |                       |
|              |       |                       |                       |
|              |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
|              |       |                       | Plant                 |
|              |       |                       |                       |
|              |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
|              |       |                       | Permit No.            |
|              |       |                       |                       |
|              |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
| Inspection   |       |                       |                       |
| of your      |       |                       |                       |
| dairy farm   |       |                       |                       |
| today showed |       |                       |                       |
| violations   |       |                       |                       |
| existing in  |       |                       |                       |
| the Items    |       |                       |                       |
| checked      |       |                       |                       |
| below. You   |       |                       |                       |
| are further  |       |                       |                       |
| notified     |       |                       |                       |
| that this    |       |                       |                       |
| inspection   |       |                       |                       |
| report       |       |                       |                       |
| serves as    |       |                       |                       |
| notification |       |                       |                       |
| of the       |       |                       |                       |
| intent to    |       |                       |                       |
| suspend your |       |                       |                       |
| permit if    |       |                       |                       |
| the          |       |                       |                       |
| violations   |       |                       |                       |
| noted are    |       |                       |                       |
| not in       |       |                       |                       |
| compliance   |       |                       |                       |
| at the time  |       |                       |                       |
| of the next  |       |                       |                       |
| inspection.  |       |                       |                       |
| (Refer to    |       |                       |                       |
| Sections 3   |       |                       |                       |
| and 5 of the |       |                       |                       |
| **Grade "A"  |       |                       |                       |
| Pasteurized  |       |                       |                       |
| Milk         |       |                       |                       |
| O            |       |                       |                       |
| rdinance**.) |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
| **COWS**     |       | ***Cleaning           | **TRANSFER/PROTECTION |
|              |       | Facilities***         | OF MILK**             |
| 1\.          |       |                       |                       |
| **Abnormal   |       | Two-compartment wash  | 14\. **Protection     |
| Milk:**      |       | and rinse vat of      | From Contamination:** |
|              |       | adequate size (a)     |                       |
| Cows         |       |                       | No overcrowding (a)   |
| secreting    |       | Suitable water        |                       |
| abnormal     |       | heating facilities    | Product and           |
| milk milked  |       | (b)                   | mechanical cleaning   |
| last or in   |       |                       | circuits separated    |
| separate\    |       | Water under pressure  | (b)                   |
| equipment    |       | piped to milkhouse    |                       |
| (a)          |       | (c)                   | Improperly handled    |
|              |       |                       | milk discarded (c)    |
| Abnormal     |       | 6\. **Cleanliness:**  |                       |
| milk         |       |                       | Immediate removal of  |
| properly     |       | Floors, walls,        | milk (d)              |
| handled and  |       | windows, tables and   |                       |
| disposed of  |       | similar non-product   | Milk and equipment    |
| (b)          |       |                       | properly protected    |
|              |       | contact surfaces      | (e)                   |
| Proper care  |       | clean (a)             |                       |
| of abnormal  |       |                       | Sanitized milk        |
| milk         |       | No trash, unnecessary | surfaces not exposed  |
| handling     |       | articles, animals or  | to contamination (f)  |
| equipment    |       | fowl (b)              |                       |
| (c)          |       |                       | Air under pressure of |
|              |       | **TOILET AND WATER    | proper quality (g)    |
| **MILKING    |       | SUPPLY**              |                       |
| BARN,        |       |                       | 15\. **Drug and       |
| STABLE, OR   |       | 7\. **Toilet:**       | Chemical Control:**   |
| PARLOR**     |       |                       |                       |
|              |       | Provided;             | Cleaners and          |
| 2\.          |       | conveniently located  | sanitizers properly   |
| **Con        |       | (a)                   | identified (a)        |
| struction:** |       |                       |                       |
|              |       | Constructed and       | Drug administration   |
| Floors,      |       | operated according to | equipment properly    |
| gutters, and |       | *Ordinance* (b)       | handled and stored    |
| feed troughs |       |                       | (b)                   |
| of concrete  |       | No evidence of human  |                       |
| or equally\  |       | wastes about premises | Drugs properly        |
| impervious   |       | (c)                   | labeled (name and     |
| materials;   |       |                       | address) and stored   |
| in good      |       | Toilet room in        | (c)                   |
| repair (a)   |       | compliance with       |                       |
|              |       | *Ordinance* (d)       | Drugs properly        |
| Walls and    |       |                       | labeled (directions   |
| ceilings     |       | 8\. **Water Supply:** | for use, cautionary   |
| smooth,      |       |                       | state­\                |
| painted or   |       | Constructed and       | ments, active         |
| finished     |       | operated according to | ingredient(s)) (d)    |
| adequately;  |       | *Ordinance* (a)       |                       |
| in           |       |                       | Drugs properly used   |
|              |       | Complies with         | and stored to         |
| good repair; |       | bacteriological       | preclude              |
| ceiling      |       | standards (b)         | contamination         |
| dust-tight   |       |                       |                       |
| (b)          |       | No connection between | of Milk (e)           |
|              |       | safe and unsafe       |                       |
| Separate     |       | supplies; no\         | **PERSONNEL**         |
| stalls or    |       | improper submerged    |                       |
| pens for     |       | inlets (c)            | 16\. **Handwashing    |
| horses,      |       |                       | Facilities:**         |
| calves, and  |       | **UTENSILS AND        |                       |
| bulls; no\   |       | EQUIPMENT**           | Proper handwashing    |
| overcrowding |       |                       | facilities convenient |
| (c)          |       | 9\. **Construction:** | to milking\           |
|              |       |                       | operations (a)        |
| Adequate     |       | Smooth, impervious,   |                       |
| natural      |       | nonabsorbent, safe    | Wash and rinse vats   |
| and/or       |       | materials;\           | not used as           |
| artificial   |       | easily cleanable (a)  | handwashing           |
| light; well  |       |                       | facilities (b)        |
| distributed  |       | In good repair;       |                       |
| (d)          |       | accessible for        | 17\. **Personnel      |
|              |       | inspection (b)        | Cleanliness:**        |
| Properly     |       |                       |                       |
| ventilated   |       | Approved              | Hands washed clean    |
| (e)          |       | single-service        | and dried before      |
|              |       | articles; not reused  | milking, or           |
| 3\.          |       | (c)                   | performing\           |
| **Cl         |       |                       | milkhouse functions;  |
| eanliness:** |       | Utensils and          | rewashed when         |
|              |       | equipment of proper   | contaminated (a)      |
| Clean and    |       | design (d)            |                       |
| free of      |       |                       | Clean outer garments  |
| litter (a)   |       | Approved mechanically | worn (b)              |
|              |       | cleaned milk pipeline |                       |
| No swine or  |       | system (e)            | **COOLING**           |
| fowl (b)     |       |                       |                       |
|              |       | 10\. **Cleaning:**    | 18\. **Cooling:**     |
| 4\.          |       |                       |                       |
| **Cowyard:** |       | Utensils and          | Milk cooled to 45°F   |
|              |       | equipment clean (a)   | or less within 2      |
| Graded to    |       |                       | hours after milking,\ |
| drain; no    |       | 11\.                  | except as permitted   |
| pooled water |       | **Sanitization:**     | by *Ordinance* (a)    |
| or wastes    |       |                       |                       |
| (a)          |       | All multi-use         | Recirculated cooling  |
|              |       | containers and        | water from safe       |
| Cowyard      |       | equipment subjected   | source and properly\  |
| clean;       |       | to approved           | protected; complies   |
| cattle       |       | sanitization process  | with bacteriological  |
| housing      |       | (Refer to             | standards (b)         |
| areas and    |       | *Ordinance*) (a)      |                       |
| manure       |       |                       | An acceptable         |
| packs\       |       | 12\. **Storage:**     | recording device      |
| properly     |       |                       | shall be installed    |
| maintained   |       | All multi-use         | and\                  |
| (b)          |       | containers and        | maintained when       |
|              |       | equipment properly    | required (c)          |
| No Swine (c) |       | stored (a)            |                       |
|              |       |                       | **PEST CONTROL**      |
| Manure       |       | Stored to assure      |                       |
| stored       |       | complete drainage,    | 19\. **Insect and     |
| inaccessible |       | where applicable (b)  | Rodent Control:**     |
| to cows (d)  |       |                       |                       |
|              |       | Single-service        | Fly breeding          |
| **MILKHOUSE  |       | articles properly     | minimized by approved |
| OR ROOM**    |       | stored (c)            | manure disposal\      |
|              |       |                       | methods (Refer to     |
| 5\.          |       | **MILKING**           | *Ordinance)* (a)      |
| **           |       |                       |                       |
| Construction |       | 13\. **Flanks,        | Manure packs properly |
| and          |       | Udders, and Teats:**  | maintained (b)        |
| F            |       |                       |                       |
| acilities:** |       | Milking done in barn, | All milkhouse         |
|              |       | stable, or parlor (a) | openings effectively  |
| ***Floors*** |       |                       | screened or           |
|              |       | Brushing completed    | otherwise\            |
| Smooth;      |       | before milking begun  | protected; doors      |
| concrete or  |       | (b)                   | tight and             |
| other        |       |                       | self-closing; screen  |
| impervious   |       | Flanks, bellies,      | doors open\           |
| material; in |       | udders, and tails of  | outward (c)           |
| good repair  |       | cows clean at time    |                       |
| (a)          |       | of\                   | Milkhouse free of     |
|              |       | milking; clipped when | insects and rodents   |
| Graded to    |       | required (c)          | (d)                   |
| drain (b)    |       |                       |                       |
|              |       | Teats cleaned,        | Approved pesticides;  |
| Drains       |       | treated with          | used properly (e)     |
| trapped, if  |       | sanitizing solution   |                       |
| connected to |       | (if required) and\    | Equipment and         |
| sanitary     |       | dried, just prior to  | utensils not exposed  |
| system (c)   |       | milking (d)           | to pesticide\         |
|              |       |                       | contamination (f)     |
| ***Walls and |       | No wet hand milking   |                       |
| Ceilings***  |       | (e)                   | Surroundings neat and |
|              |       |                       | clean; free of        |
| Approved     |       |                       | harborages and\       |
| material and |       |                       | breeding areas (g)    |
| finish (a)   |       |                       |                       |
|              |       |                       | Feed storage not      |
| Good repair  |       |                       | attraction for birds, |
| (windows,    |       |                       | rodents or insects    |
| doors, and   |       |                       | (h)                   |
| hoseport     |       |                       |                       |
| included)    |       |                       |                       |
| (b)          |       |                       |                       |
|              |       |                       |                       |
| ***Lighting  |       |                       |                       |
| and          |       |                       |                       |
| Ve           |       |                       |                       |
| ntilation*** |       |                       |                       |
|              |       |                       |                       |
| Adequate     |       |                       |                       |
| natural      |       |                       |                       |
| and/or       |       |                       |                       |
| artificial   |       |                       |                       |
| light;       |       |                       |                       |
| properly     |       |                       |                       |
| distributed  |       |                       |                       |
| (a)          |       |                       |                       |
|              |       |                       |                       |
| Adequate     |       |                       |                       |
| ventilation  |       |                       |                       |
| (b)          |       |                       |                       |
|              |       |                       |                       |
| Doors and    |       |                       |                       |
| windows      |       |                       |                       |
| closed       |       |                       |                       |
| during dusty |       |                       |                       |
| weather (c)  |       |                       |                       |
|              |       |                       |                       |
| Vents and    |       |                       |                       |
| lighting     |       |                       |                       |
| fixtures     |       |                       |                       |
| properly     |       |                       |                       |
| installed    |       |                       |                       |
| (d)          |       |                       |                       |
|              |       |                       |                       |
| ***M         |       |                       |                       |
| iscellaneous |       |                       |                       |
| Req          |       |                       |                       |
| uirements*** |       |                       |                       |
|              |       |                       |                       |
| Used for     |       |                       |                       |
| milkhouse    |       |                       |                       |
| operations   |       |                       |                       |
| only;        |       |                       |                       |
| sufficient   |       |                       |                       |
| size (a)     |       |                       |                       |
|              |       |                       |                       |
| No direct    |       |                       |                       |
| opening into |       |                       |                       |
| living       |       |                       |                       |
| quarters or  |       |                       |                       |
| barn, except |       |                       |                       |
| as\          |       |                       |                       |
| permitted by |       |                       |                       |
| *Ordinance*  |       |                       |                       |
| (b)          |       |                       |                       |
|              |       |                       |                       |
| Liquid       |       |                       |                       |
| wastes       |       |                       |                       |
| properly     |       |                       |                       |
| disposed of  |       |                       |                       |
| (c)          |       |                       |                       |
|              |       |                       |                       |
| Proper       |       |                       |                       |
| hoseport     |       |                       |                       |
| where        |       |                       |                       |
| required (d) |       |                       |                       |
|              |       |                       |                       |
| Acceptable   |       |                       |                       |
| surface      |       |                       |                       |
| under        |       |                       |                       |
| hoseport (e) |       |                       |                       |
|              |       |                       |                       |
| Suitable     |       |                       |                       |
| shelter for  |       |                       |                       |
| transport    |       |                       |                       |
| truck as     |       |                       |                       |
| required (f) |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
| REMARKS      |       |                       |                       |
|              |       |                       |                       |
|              |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
| DATE         | SANIT |                       |                       |
|              | ARIAN |                       |                       |
|              |       |                       |                       |
|              |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+
| Note: Item   |       |                       |                       |
| numbers      |       |                       |                       |
| correspond   |       |                       |                       |
| to required  |       |                       |                       |
| sanitation   |       |                       |                       |
| Items for    |       |                       |                       |
| Grade "A"    |       |                       |                       |
| raw milk for |       |                       |                       |
| pa           |       |                       |                       |
| steurization |       |                       |                       |
| in the       |       |                       |                       |
| **Grade "A"  |       |                       |                       |
| Pasteurized  |       |                       |                       |
| Milk         |       |                       |                       |
| Ordinance**. |       |                       |                       |
+--------------+-------+-----------------------+-----------------------+