Survey
Request Form NYS Dept. of Ag and Markets, Division of Milk Control |
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I wish to enroll in Quality Milk Production Services and have a herd survey done at the earliest convenience.
(Print this form and fill out as completely and legibly as possible. Upon completion, please send to :)
Quality Milk Production Services
22 Thornwood Drive
Ithaca, NY 14850
Name: _______________________________________ Address:________________________________________
Town, State and Zip Code: _____________________________________ County:_________________________
Phone(s):______________________________________________ Best Time
to Call:______________________
Fax:___________________________________ Email:________________________________________________
Directions to Farm:____________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Veterinarian:___________________________________
Milk Inspector: ________________________________
Address:______________________________________
Milk Plant/BTU: ________________________________
_____________________________________________
Address:_____________________________________
Phone: ____________________ Fax:_______________
Phone: ___________________ Fax:_______________
Nature of Problem: High Cell Counts __________ High Clinicals __________ High bacteria counts_____________
Other Problems:________________________________________________________________________________
Comments:____________________________________________________________________________________
_____________________________________________________________________________________________
Date:________________ Producer Signature:_______________________________________________________
