ALLEGATO I
PIANO DI ERADICAZIONE E SORVEGLIANZA MALATTIA VESCICOLARE DEI SUINI
ANNO 1997
SCHEDA DI ACCOMPAGNAMENTO CAMPIONI
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REGIONE ____________________ AZ. USL ______ TEL _______________
MOTIVO DEL CAMPIONAMENTO (barrare una sola casella):
SORVEGLIANZA IN AZIENDA GIA' ACCREDITATA |_| (B)
RIACQUISIZIONE DELL'ACCREDITAMENTO primo prelievo |_| (C)
secondo prelievo |_| (D)
CONTROLLO IN STALLA DI SOSTA |_| (E)
A SEGUITO DI SIEROPOSITIVITA' RISCONTRATA IN AZIENDA |_| (G)
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CODICE IDENTIFICAZIONE AZIENDA "NUOVO" (D.P.R. 317/1996)
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CODICE IDENTIFICAZIONE AZIENDA "PRECEDENTE"
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INDIRIZZO PRODUTTIVO: |_|Riproduzione |_|Misto |_|Ingrasso |_|Stalla
di sosta
PROPRIETARIO ________________________________________________________
PROVINCIA ____ COMUNE __________________ LOCALITA' __________________
N. RIPRODUTTORI PRESENTI __________ N. CAPI PRESENTI __________
DATA PRELIEVO CAMPIONI ____________ TIPO CAMPIONE SANGUE |_|N. _____
FECI |_|N. _____
EPITELIO|_|N. _____
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QUADRO ASL QUADRO IZS COMPETENTE QUADRO CENTRO REF.
MARCHE AURICOLARI ESITO ELISA CONFERMA/ESITO
DEI SUINI CAMPIONATI IZS _________________ VIROLOGIA
N. PROT. ____________ N. PROT. ____________
DATA ________________ DATA ARRIVO _________
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FIRMA E TIMBRO DEL FIRMA DEL RESPONSABILE FIRMA DEL RESPONSABILE
VETERINARIO ASL LABORATORIO LABORATORIO
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