Form LSAD101F7.4 "Antibiotic Testing Form" - Nova Scotia, Canada

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Download Form LSAD101F7.4 "Antibiotic Testing Form" - Nova Scotia, Canada

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Agriculture Protection/Analytical Services
Agriculture Protection/Analytical Services
65 River Rd, Truro, Nova Scotia, B2N 2P3
65 River Rd, Truro, Nova Scotia, B2N 2P3
Tel: 902-893-6540
Fax: 902-895-6684
Tel: 902-893-6540
Fax: 902-895-6684
ANTIBIOTIC TESTING
ANTIBIOTIC TESTING
MILK SAMPLE
MILK SAMPLE
Name: __________________________________________
Name: __________________________________________
Address: ________________________________________
Address: ________________________________________
_________________________________________
_________________________________________
Postal Code: ____________
Postal Code: ____________
Tel _________________ Fax _________________
Tel _________________ Fax _________________
Email _____________________________________
Email _____________________________________
Tank Sample
Cow Sample
Tank Sample
Cow Sample
Federal Registration Number _____________________
Federal Registration Number _____________________
Date Sampled
_____________________
Date Sampled
_____________________
Beta-Lactams (penicillin family) Test __________
Beta-Lactams (penicillin family) Test __________
Sulfamethazine Test
__________
Sulfamethazine Test
__________
Signature: _________________________________
Signature: _________________________________
Specimens are analyzed as provided. The laboratory takes no
Specimens are analyzed as provided. The laboratory takes no
responsibility for the accuracy of the information provided by the person
responsibility for the accuracy of the information provided by the person
submitting the sample (i.e. source)
submitting the sample (i.e. source)
LAB REPORT
LAB REPORT
Accession Number
____________
Accession Number
____________
Beta-Lactams (penicillin family) ____________
Beta-Lactams (penicillin family) ____________
Sulfamethazine
____________
Sulfamethazine
____________
Technologist: ______________________________
Technologist: ______________________________
Date:
__________________________________
Date:
__________________________________
LSAD101F7.4
LSAD101F7.4
Agriculture Protection/Analytical Services
Agriculture Protection/Analytical Services
65 River Rd, Truro, Nova Scotia, B2N 2P3
65 River Rd, Truro, Nova Scotia, B2N 2P3
Tel: 902-893-6540
Fax: 902-895-6684
Tel: 902-893-6540
Fax: 902-895-6684
ANTIBIOTIC TESTING
ANTIBIOTIC TESTING
MILK SAMPLE
MILK SAMPLE
Name: __________________________________________
Name: __________________________________________
Address: ________________________________________
Address: ________________________________________
_________________________________________
_________________________________________
Postal Code: ____________
Postal Code: ____________
Tel _________________ Fax _________________
Tel _________________ Fax _________________
Email _____________________________________
Email _____________________________________
Tank Sample
Cow Sample
Tank Sample
Cow Sample
Federal Registration Number _____________________
Federal Registration Number _____________________
Date Sampled
_____________________
Date Sampled
_____________________
Beta-Lactams (penicillin family) Test __________
Beta-Lactams (penicillin family) Test __________
Sulfamethazine Test
__________
Sulfamethazine Test
__________
Signature: _________________________________
Signature: _________________________________
Specimens are analyzed as provided. The laboratory takes no
Specimens are analyzed as provided. The laboratory takes no
responsibility for the accuracy of the information provided by the person
responsibility for the accuracy of the information provided by the person
submitting the sample (i.e. source)
submitting the sample (i.e. source)
LAB REPORT
LAB REPORT
Accession Number
____________
Accession Number
____________
Beta-Lactams (penicillin family) ____________
Beta-Lactams (penicillin family) ____________
Sulfamethazine
____________
Sulfamethazine
____________
Technologist: ______________________________
Technologist: ______________________________
Date:
__________________________________
Date:
__________________________________
LSAD101F7.4
LSAD101F7.4