City of fitchburg.
BURG
FITCH
HEALTH DEPARTMENT, ROOM 1 7, CITY HALL.
APPLICATION FOR A LICENSE TO CONVEY
MILK FOR THE PURPOSE OF SALE
convey milk in the City of Fitchburg, in accordance with the
The undersigned hereby applies for a License
Laws of the Commonwealth and the Rules and Regulations of the Board of Health of the City of Fitchburg.
Date of Application
Number of License
19
Business name
Name of owner
manager
Residence
Place of business
Number
the conveyance or delivery of milk
wagons or vehicles used
Name of owner
wagons or vehicles used
milk
Wil you have your name and license number plainly marked on all vehicles used for the conveyance
na color that is .
sharp contrast to the color of the
(in letters and numbers at least one inch in height,
vehicle used, on each outer side thereof ?)
Number of drivers employed
RESIDENCE
NAMES OF DRIVERS.
Cans
Wholesale
Mlk
Cans
Retail
NUMBER OF CANS OF MILK, SKIMMED MIL simmed Milk
Cans
Wholesale
Cans
CREAM SOLD PER DAY IN PITCHBURG
Retail
Quarts
Wholesale
Cream
Retail
Quarts
Route,
(Give principal streets
r district)
Time of delivery
MILK ROOM.
Location of milk room
If vou have
separate milk room, where do you handle your milk?
..
that they can be easily cleaned?
Are the walls tight and smooth
Is the Boor so constructed that it can be casily cleaned and drained?
Are the ice box and ice tank used for milk drained, and how?
Have you proper appliances for washing or sterilizing all milk utensils used ?
e milk vessels and utensils washed?
Where are
icense is granted vou, will you agree to wash or direct the washing of all milk vessels and ute
If
by you?
