Document 5D8ozM3vy7d14Rx832dBp7erV

ANALYST WORK SHEET 3. SEALS I I IN TA C T H T bwoken I I NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T -f. I <=. ' C i 4. DATE RECO 5. R E C E IV E D FROM ' , , . 'T 2. S A M P LE N UMBER Ti 6. DISTR IC T OR DIVISION , ' </ 8. NET CON TENTS ["* 1N O T A P P L I C A B L E j NOT DETERMINED .( | u n i t s E x a m i n e d 10. SUMMARY O F A NA LYSIS | DECLARED AMOUNT FOUND % o f d e c l a r e d .. 9. Label in g ) ORI GIN A L(S) S U B M I T T E D I I __________________ ^ C O P I E S S U B M I T T E D I I NONE 7. 3. A i? / /a /c . & // c i^ / ' ic ? C O ' i t f r / n a - n 1 r .. . /-~ O / ,/ "Y / * J P to / l& /< * A S ' ? // / f ! / ^ -- 7 *7 -a h -o A c - , r . / f r -3 0 t* T ~ U /r X < P ///C ^ U A" < A, / / '} & C* C <sr* ' c - tCi >A * & '- C 1 11. R E S E R V E SA M P LE 12. D A T E REPORTED -7/ / . y" ^ /p '/7 13a. A N A LY S T f; NAME, 'S - . b \/. 15. PROGRAM D A T A OP E R A T I O N '1TM J-M S, HP PROBLEM H ia / dcc no // ACTIVITY NO. OF .O TS FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . tab. NUMBER 13c. PC 14. CALCULA TIONS CHECKED b. DA TE M E T H O D (C h e c k no m ore th a n tw o ) (A ) ^ M A C R O S C O P I C (M ) r^T iv iT c R O S C O P I C (X ) |X .- R A Y (F ) FIELD EXAM (P ) PHY EXAM ( " B ; Q b A C T (O ) I |p RG AN (C ) CHEM (N ) Q w / O AN AL (L ) BIO GPO 934-261 e */ ANALYST WORK SHEET 3. SEALS L J in ta c t K b ROKEN n NONE }. D E S C R I P T I O N O F S A M P L E t. PRODUCT 1 , -, L ____ J L a C:,' >- -Vi-. 4, DATE RECD S. RECEIVED FROM f/ / a&SL ~ r ~ ~ r -----------------~ 2. SAM PLE N U M BER fi / 6. D IS T R IC T OR DIVISIO N - ! e. ' NET I CON TENTS H n OY APPLICABLE "INOT DETERMINED n UNITS EXAMINED to. SUMMARY OF ANALYSIS I I DECLARED AMOUNT FOUND % OF DECLA RED 9. La b e l in g ORI GINAL(S) SU B M IT T E D [" ] C O PI E S S U BM1 T T E D | | NONE & V ' 7L5 / > ,/ ? O* # r 5 ./r A/:? / J : .. W' /- o > (.i ; t - ? / " (<" /!' -L ;0 / / S ' .7 /Ac A i / v ./ '/ ^ /V i /z, /: / / S , / A < rV / b C s /irU S / y ^ - / / ,/ / /. / - / / 7 V ;" / ^ r / v / k a *<U v'1 ^ 11. R E S E R V E SA M P LE 2, DATE REPORTED ./ * "7 14/ fy r ' ' 15. PROGRAM D A T A 1. 2. 3- FD FO RM 431 (8/72] 13e. A N A L Y S T fs ; NAME, </ / / 7/; L3b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED OP ERA TION A C T IV I TY NO. P RE. V I O U S E D I - r i o t ' i s D BS O L I 7 E. M E T H O D (C h e c k no m ore th e n tw o ) (A ) m a c r o s c o p i c (M ) P T ' mi' c r q s c o p i C (X ) X , R A Y (F ) n F IELD EXAM (P ) PHY EXAM (B ) [ ) BA C T (O ) I lORGAN (C ) CHEM (N ) Q W / O A N A L (L ) BIO GP 0 934-26 ANALYST WORK SHEET 3. SEALS 1 in t a c t broken n NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T ! r . o n . n -7 * 4. D A tE RECD 5. R E C E IV E D FROM ^ 7 -S/ 1 . / 2. SAM PLE NUM BER fd > 6. D IS TR IC T OR DIVISION Pb* ,, ' t . s. ' ` : L I eNET CON TENTS Q n OT APPLICABLE r~l N O T D E T E R M I N E D ) UNITS EXAMINED 10. SUMMARY O F A N A L Y S IS I I DECLARED AMOUNT FOUND, % O F D E C L A R E D ____ / c .-- Cf A .V 9. La b e l in g | } ORIGINAL(S) SUBMITTED | | _________________ _ _ _ C O P I E S S U B M I T T E D | | NONE ? , L y .< < b o v t * y .5 a r --s H. / r . f / r A ' . ' - / ( ' l * -- * - /' / s ' J // A? < C/ / t J < r " ./ A , / 1 / r . < - / 5 t- 1t. RESERVE SAMPLE k V* -^ 5 ,A T , 12. D A T E REPORTED rT 13a. A N A L Y S T ^ ; NAME ~7 13b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED 15. PROGRAM D A T A MS. HP.., PROBLEM OP ERATION HJ H I A / D C C NO A C TI VI T Y NO. ,O TS HOURS FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . M E T H O D (C h e c k no m ore th a n tw o ) (A ) m a c r o s c o p i c (m ) R - t o t c r o s c o p i C ( X ) Xj R A Y ( F ) F I E L D E X A M (P ) PHY EXAM P j D B A C T (O) | ORGAN (C ) CHEM (N ) W / O A N A L (L ) BIO GPO 934-26 AN A LY S T WORK SHEET 3. SEALS L_J IN TAG T Q J BROKEN CD NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T / r ,u,7 A. dYe rec o < s. r e c e Tv e d f r o m ______ / _ er hhu 2. SAM PLE N UMBER ri |S. D I S T R I C T OR D I V I S I O N -<c ! s. ; NET ; CON` TENTS ( NOT APPLICABLE i | NOT DETERMINED Q y N I T S EXAMINED 10, S U M M A R Y O F A N A L Y S I S | | DECLARED AMOUNT FOUND % OF DECLARED i, " 9. La b e l in g I O R I GI N A U S ) SU BMI T T E D I I ____________ CO PI E S S U B M I T T E D I I NONE *- i * /-/ / 2 \y , ,' / ' , "7 L\ * _i~ . C, ' > - L/- ...... / < ^ * / / t C -- - L i , -r >' - . < 1 V ... />. / c 7 / -C /X ' <. * ^ ' ,, f <t 1 - -> . - < . . r '" y * /? > .* ' ' * / i ' _n' / jt- . ' / </ < < ' s J X lL' / < / 1 t <" 11. R E S E R V E S A M P L E 12. D A T E REPORTED ,/ r- c : JA ' 13c. A N A L Y S T fs; NAME [ 1- -V L ./ ./ u -(/ 13b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED a. BY b. DATE m PRmtiN H 1A /D C C NO. , OTS FC FORM 431 (S/72) P R E V I O U S E D I T I O N IS O B S O L E T E . (A ) m a c r o s c o p i c (m ) R t h t r o s c o p i c (X ) X . . R A Y (F ) FIELD EXAM (P ) PHY EXAM ( B ; Q b A C T (O ) I | o RG AN (C ) CHEM (N ) Q w / O A N A L ( L ) BIO GPO 934-261 I ANALYST WORK SHEET 3. S EA LS l_) IN T A C T Q23 B R O K E N PH NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T 4. D A T E RECO -- ' .*/ * ' 5. R E C E IV E D FROM ' --5 V 2. S A M P L E NUM B ER 6. D IS T R IC T OR D IVISION / Jj h -' / /. ./T-- / 6. NET CON TENTS f~~l N O T A P P L I C A B L E Q n o t DETERMINED u n its exam ined 10. S U M M AR Y O F A N A L Y S IS ^/ / I I DECLARED amount found, % O F D E C L A R E D ____ / c. '`L.i-' . (%w*v l '? : / / - v . ' >- A - '- ''l Co. Y . / U J C * ' H rat. J s. tA B E L - NG MOB I 1 O R I GI N A L ( S ) SU BMI T T E D I ] _____________________ C O P I E S S U B M I T T E D I I NONE . C. ' 'J" ( ^ .r _ r*. 6.J 1 L^l / / O ia / C 11. R E S E R V E S A M P L E 12. D A T E REPORTED a '/ 13 e . A N A L Y S T ^ ; N A M E // 13b. NUMBER 13c. PC 14. ^CALCULA TIONS CHECKED b. DATE 15, PROGRAM D ATA US papp.i-^M OP ERATION H IA /P C C NO ACTIVI TY NoOr. LO TS HOURS M E T H O D (C h e c k no m ore th a n tw o ) (A ) M A C R O S C O P I C (M ) M I C R O S C O P I C (X ) XrRAY (F ) FIELD EXAM (P ) PHY EXAM (B ) Q b A C T ( O ) I | p R G AN (C ) CHEM (N ) w / O A N A L (L ) I I BIO FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . GPO 934-261 FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . GPO 934-261 ANALYST WORK SHEET 3. SEALS f 1INTACT -BRO KEN Q NONE 7. DESCRIPTION OF SAMPLE PRODUCT / 4. D A T E R E C D , .y , . 1* , * v 5. R E C E IV E D FROM v/ *r * / * 2. SAMPLE NUMBER 6. D IS TR IC T OR DIVISION e. NET CON TENTS Q n o t a ppl ic a b l e Q n o t d eter m in ed u n it s exa m in ed to. SUMMARY OF ANALYSIS r IDECLARED amount found. % O F D E C L A R E D ____ y/ .X' / / ( /< I | ORIGINAL(S) SUBMITTED | | ____________________ C O P I E S S U B M I T T E D I | N ON E /' f ` ,> / ' 4- / . 7 j g . & f '/ V i' - it / c 1 1. R E S E R V E S A M P L E 12. D A T E REPORTED Li f i * * 7 * / 1 3 bT a N A L , y S T f s J N M AyW. 15, PROGRAM D ATA EMS, HP.. PROB LE V O P E RA T I O N H A /P C C NO. ACTIVITY NO. OF C <s FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . 13b. "Nu m b e r 13c. PC 14. CALCULA TIONS CHECKED b. D A TE M E T H O D (C h e c k no m ore th e n tw o ) (A ) m a c r o s c o p i c (M ) m i c r o s c o p i c ( X ) X.*RAY ( F ) I I FI E L D E X A M (P ) PHY EXAM ( B J O b A C T (O ) I ORGAN (C ) CHEM (N ) Q W / O A N A L (L ) BIO GPO 934-26 FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . GPO 934-261 ANALYST WORK SHEET 1. P R O D U C T S M O /h , . V t . 2. SAMPLE NUMBER yc r" O '0 3. SEALS INTACT 4. D ATE RECO 5. R E C E IV E D Ff?OM 6. D IS T R IC T OR DIVISION L 2 f e R OKEN P I NONE 7. DESCRIPTION OF SAMPLE iS r ; / / ' i\ ' ff ,? > < r 7 6. NET CON TENTS n ot a ppl ic a b l e I I NOT DETERMINED I Iu n its E xamined 10. SU M M AR Y O F ANA LYSIS j I DECLARED amount found, % OF DECLARED , sty 9 La b e l in g Q 3 O Rl GIN A Lt S) S U B M I T T E D | | COPIES SUBMITTED 1 | NONE \ }< K > 11 ' a C sl / (J ty /& //> /- / \ JJ T / /c r << . . *2 * . // / / h , -c < y - . , yL c j f , C J } . I , r / j. ,, / 7- 7 <, $ ^ :y yy 11. R E S E R V E S A M P L E 12. D A T E REPORTED // 77 / 15. PROGRAM D A T A FD FORM 431 (8/72) 13e. A N A L Y S T fe ; NAME V V . >- , ... - V OPERATION H I A / D C C NO ;/ j . ACTIVITY NO. OTS P R E V I O U S E D I T I O N IS O B S O L E T E . 13b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED b. DATE M E T H O D (C h e c k no m ore th a n tw o ) (A ) M A C R O S C O P I C (M ) CROSCOPI C (X ) X.-RAY (F ) F I E L D EX AM (P ) PHY EXAM (B ) I IBAC T (O) I ORGAN (C ) CHEM (N ) w / O AN A L (L ) BIO GPO 934-261 AN ALYST WORK SHEET 3. SEALS INTA CT I'T ' b r o k e n none 7. DESCRIPTION OF SAMPLE 1. P R O D U C T ___ L u>/h ja -- -r ( 4. D A T E RECD 5. R E C E IV E D Ff^OM , 2. SA M PLE NUMBER .P " Co o 6. D IS TR IC T OR DIVISION UU- 8. NET CON- [ TENTS n ot a ppl ic a b l e n o t DETERMINED P I UNITS EXAMINED 10. SUMMARY O F A N A L Y S IS j | DECLARED AMOUNT FOUND. % OF DECLARED. 9. La b el in g ORIGtNAL(S) SUBMITTED | | _____________________ C O P I E S S U B M I T T E D | | NONE -'T f f ,\ a / /, - / / s , - * f O' / -- A " (V / w . / ' t fa L / , / // S'- f v h < o JA - ; 1'L 4L- I , u j 17 / sj \ O V / Cl t 5 O ' ' * ^ ' k; f) 1t. RESERVE SAMPLE 12. D A T E REPORTED / 7 47 15. PROGRAM D A T A 13. A N A LY S T fe) NAME V L V ' T JO P E R A T I O N P M S P RPfjl - E.Vl H IA /D C C NO V, 13b. NUMBER 13c. PCfU. CALCULA TIONS CHECKED A C T l VI T Y Nt O . OF -O T S HOURS M E T H O D (C h e c k no more than tw o) (A ) M A C R O S C O P I C (M) P H ^ c r o s c o p i c (X ) X r R A Y (F ) | | Fi E L D EXAM (P) P H Y EXAM ( B J Q b A C T ( O ) I |p R G AN ( C) C H E M (N ) | |W/Q A N A L ( L ) I I B I O FD FORM 431 (8/72) P R E V I O U S E D IT I O N IS O B S O L E T E . GPO 934-261 --------- a TM -- TM TM U PRODUCT t ! ANALYST WORK SHEET e f c< t? / V ^ 2. S A M P L E N U M B E R 7) ^ ^ ^ - - - O' j- 3. SEALS in t a c t 4. D A T E R E C D 5. R E C E I V E D F R O M 6. D IS TR IC T OR DIVISION broken CD n o n e 7. DESCRIPTION OF S A M P LE ,/c ^ > . Z' / y--^ // / / cv c O 'C Z T /V s. NET i CON* TENTS P i NOT APPLICABLE { |N O T DETERMINED | 1 UNITS EXAMINED 10, S U M M ARY O F A N A L Y S IS | | DECLARED AMOUNT FOUND % OF DECLARED . 9" La b e l in g I I O R 1GINAL(S) S U B M IT T E D | ] _____________________ C O P I E S S U B M I T T E D | | N ON E / . c uns ju i * * * * " o " ' C ' /'O o > t ^ 7 L J. 1 (_>' t:- z ,, - / / n <>(a / / 7:<l / r - -C / - N* _l" / /'Vf c o . / V / /v tf-C- /7 g?i f C y - -+7 Z ./-/Cij / <$ t U te / 1 ; / --L T'..- / " o', c t . '; v /. // c - ' -/ <SC f K. \C V cr ' ' <^OV' }r-/rr<y'c- 11. R E S E R V E S A M P L E 12. D A T E REPORTED ? - 'L Z a ; 7 15. PR O G R AM D A T A FD FORM 431 (8/72) 13s. ANA LYSTf; NAME 13b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED OP ERA TION a / d c c no A C T ! VI T Y NO. ,,OO FTS P R E V I O U S E D IT I O N IS O B S O L E T E . M E T H O D (C h e c k no more then tw o) (A ) m a c r o s c o p i c (m ) m i c r o s c o p i c (X ) X..RAY ( F ) | | FI E L D E X AM (P ) PHY EXAM (B ) BA C T (O) I |o RG AN (C ) C H E M (N) Q w / O A N A L (L ) BIO 6 P 0 934-261 ^SSgsaaBBmSi^sssaBiEsaisa^^agsges5^^ig2ggr^--i8ssaggsisg C T roducT , .K L Y S T W O R K S H E E T J ...S C ' <T / V <T ; 3. SEALS j INTACT 4. D A T E R EC . R E C E IV E D FROM (23 BROKEN Q NONE 7. OESCRIPTtQK OF SAMPLE ; / ' y r ' J - ' t ; / ' 2, V a m p l E V u m b e r i= ;> - :6. D I S T R I C T OR D IV IS I O N i / / '" V ; ... C / v - NET c o tiK Q jQ TENTS Q NOT A PPU C A B IE n o t DETERMINED u NITS EXAMINED O , S U M M A R Y O F A N A L Y S iS f | D E C L A R E D r,_. AMOUNT FOUND, % OF D C U A R E D _ La b e l fN G I I O R I Gl N A L IS) S U BMI T T E D I] _______ C O PI E S S U BMI T T E D I I NONE & - r c # 1 /?- - e. / ,r - > / VJ . / /' rr< c *. / ? s ic 0 < s *> 'V / c ^ < f /* " / v J. ' / s V \5 //i / ", v , - . - / f / c i . ` . < V'-&,, vis , CV, / -^ 6 / < * ' O W , / . v V (- t l. RESERVE SAMPLE 12. D A T E REPORTED ! A t, rr F0 FORM 431 (8 /7 2 ) 13c. A K A L Y S T fs ; KME L 13b. N UM BER :13c. PC U . CALCULA* TIONS CHECKED a. BY b. DATE OPERATION A /D C C N ) A C T l VI T Y NO. OF .OTS HOURS P R E V I O U S E D I T I O N IS O B S O L E T E . (A ) Q M A C R O S C O P I C (M) Q M I C R O S C O P I C (X ) X ? R A Y (F ) | | FI E L D E X A M (P ) Q P H Y E X A M C B ; Q b A C T CO) I | p R G AN ( C) 1 ) CHEM (N) Q [ ]w /0 A N A L (L ) B1 GPO 934-26 & /? < / tm ANALYST WORK SHEET 3. SEALS INTACT HPTb RQKEN P I NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T M. t z*A / > 4. D ATE RECO S. R E C E I V E D .FRO M 7 ., ,, r 7/ f 'f S' /> < / 2. SAM PLE NUMBER 6. D IS T R IC T OR DIVISION :> (/ ,C .' ,8. N O T A P P L I C A B L E NET CON Q NOT DETERMINED TENTS Q UNITS EXAMINED 10, SUMMARY O F A NA LYSIS | | DECLARED AMOUNT FOUND, % O F D E C L A R E D .. 9. La b e l in g ORIGINALlSl SUBMITTED | | _____ _____________ _ C O P I E S S U B M I T T E D | | NONE f ,, 7 C - - a f <l r } c t i < n /*} t U j ~z - "A / i A A . 'n A ' / r f c . -C / ' <* / i j/L C Ui > / // ^ /A ry c T 7 .y - 7 / /i 7 > ' /,i/ / c 'j - / / /a A c J 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13a. A N A L Y S T ^ ; NAME s. . ' (If g o rmy 15. PROGRAM D A T A RR08LEM OP ERA TION a / pc c no l i ?1 3b . NUMBER |13c. PC 14. CALCULA Vf;V / TIONS CHECKED b. D A TE ACTI VITY NO. ,OTS HOURS M E T H O D (C h e ck no more than tw o) (A ) Q M A C R O S C O P I C (M) 1771 Ml C RO SC O PI C (X ) X.-RAY (F ) I 1 FI E L D EX AM (P ) PHY EXAM W BA C T (Q) | ORGAN (C ) CHEM (N) Q w / O A N A L (L ) I i BIO FD FORM 431 (8/72) P R E V I O U S E D IT I O N IS O B S O L E T E . GPO 934-261 ANALYST WORK SHEET 3. SEALS 'BROKEN I I IN TA C T n NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T T' i*J / / // - 4. D A T E R E C D 5. R E C E IV E D PROM f *\ \J y ' / t ' 2. S A M P L E N U M B E R 6. D IS TR IC T OR DIVISION / -a . ^ V ( '> '1 / -- Z - --------- - NET CON TENTS I INOT APPLICABLE f I NOT DETERMINED Q u n it s EXAMINED 10. SUMMARY O F A N A L Y S IS 1 I DECLARED AMOUNT FOUND, % O F D E C L A R E D . __ 9. La b el in g j ORI GINAL(S) S U B M IT T E D I I _____________ _ _ _ _ _ _ _ C O P I E S S U B M I T T E D I I NONE / /* c ?> < ' * 7 c> / `C : ft /? J7 * / / [(/.A Y . ' i Z . . O y t/l /- $ /' -C /A c - c / /C / "c / /U A -e . -s Q KmJwi-t t /- ' *' / f. 7 . / / , ,*/. / t./ ' f - /. A: t f / r ( it ? r**- V. > <f t. & < 5 , -. y f C 11. R E S E R V E S A M P L E 12. D A T E REPORTED * ' j- A- / i TS Tp r G^M DATA MS. FD FORM 431 (8/72) 13a. ANALYSTC; NAME - 7 /> // -v 7 /ft l i b . "NUMBER 13c. P C I 14. CALCULA TIONS CHECKED b. DATE OP ERATION H IA /D C C NO. ACTIVITY NO. OF tSJES P R E V I O U S E D IT I O N IS O B S O L E T E . M E T H O D (C h e c k n o more th a n tw o) (A) m a c r o s c o p i c (M) m i c r o s c o p i c (X) X..RAY (F) F I E L D EXAM (P ) P H Y E X A M (B ) I I B A C T (O) I | p R G AN (C ) C H E M (N) W / O A N A L (L ) I I BIO GPO 934-261 AN A LYST WORK SHEET 3. SEALS j__ 1 I N T A C T r 2 r "b r o k e n (23 NONE ?. DESCRIPTION OF SAMPLE 1. PRODUCT ,<J /l- /, ' 4, D A TE RECO S. R E C E I V E D F R O M 7 J " / t. 2. S A M P L E N UM BER /? ' ^ \> ,6. D I S T R I C T OR D I V I S I O N .\ C* 'v 'J r t 8. 1 C ] NOT a p p l i c a b l e C O N * 1} \ I N O T D E T E R M I N E D TENTS [ 3 UNITS EXAMINED to. SUMMARY OF ANALYSIS 1 | DECLARED, AMOUNT FOUND, % OF DECLARED / /V / / j* \ C ( .% i <. - w - 7 \ ( > / ( - /) - Q 3 ORI GINAL(S) S U B M IT T E D II ________________ C O P I E S S U BMI T T E D I I NONE t ' <V -o &/ J( ,/ 7 < t / `- ! f ! >? : ' t - f : - . ^ -r i * ' , / C .// V */ ? ; <r 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13s. A N A LYST ^,) NAME . I// /// VSb. N U M B E R 13c. PC 1. CALCULA TIONS CHECKED b. DATE 15? P R O cH ^ A m T a t T ' M J Sa P R O B IE N FD FORM 431 (E/72) OP ERA TION H A /P C C NO. ACT1VI TY NO. OF ,O T S HOURS P R E V I O U S EDITION IS O B S O L E T E . M E T H O D ( C h e c k no m ore th e n tw o ) __ (A ) [ ] M A C R O S C O P I C (M ) [7 ? \ Ml C R O S C O P 1 C (X ) X-RAY (F ) | | F IE L D EXAM (P) P H Y E X A M e S j[H ]BACT I lo RG AN (C ) C H E M (N) w / O A N A L (L ) BIO GP 0 9 34-26! AN ALYST WORK SHEET 3. SEA LS I I INTACT P^Tbr ok en P H NONE 7. DESCRIPTION OF SAMPLE /1. P R O D U C T ZW A. D A T E R E:C D J 'f t c 5 ^ |s. r e c e iv e d f ^ m f< id ' S !2 4 h q 2. S A M P L E N UMBER 6. D IS T R IC T OR DIVISION / "V < r- ,Z . 8. NET CON- n o t APPLICABLE | N O T DETERMINED u n it s Examined i ................. - --------------------------- 10. SUMMARY O F A N A L Y S IS | 1DECLARED AMOUNT FO UND , % OF DECLARED 9. O R I G I N A L l S ) S U B M I T T E D L a b e l | | ___________________ ^ C O P I E S S U B M I T T E D ing ! | | N ON E . ! 'T / /Z , L (_ _ J ? ) P Z 5 " '/ L-CCfv t?<?h ro Z C / J ^ T - / &% =r sj . a- /- / ) / / g jw a Z /-< L 7 / Z rr O' O/ < 7 /7 z ' < - / / h - t. 7- /> / & /f 7. Z t - t w <?// /-.. * /< Z /r cf $^ t a- r c A c ^y j r t/h .4 - < y // / ! ' ( ' 1 jz Z / % . : Z j7 u f o .c y -dZs 7/ 7 ^ 7 z e/y 11. R E S E R V E S A M P L E 12. D A T E REPORTED / 15". P R G R A M D A T A ' ' -EM FD FORM 431 (6/72) 13. A N A L Y S T fe) NAME /_ z v / / / c. OP ERA TION rr A /D C C NO 3 / 13b. NUMBER !13c. PC 14. CALCULA TIONS CHECKED ACTIVITY NO. OF OTS M E T H O D (C he ck no more then tw o) (A) M A C R O S C O P I C (M) 7~1 Ml C R O S C O P I c (X ) X.-RAY (F ) | | FI E L D E X A M (P) PHY EXAM (B )\ |B A C T (O ) I ORGAN (C ) CH EM (N ) w/O ANAL. ( L ) BIO P R E V I O U S E D IT I O N IS O B S O L E T E . GPO 934-26! ANALYST WORK SHEET 3. S EALS | | IN TA C T*" r^t"BR O K EN r~ l NONE 7. DESCRIPTION OF SAMPLE \j PRODUCT ( 4? 4. D ATE RECD J j f j /5 45s,. R E C E I V E D FR O M t ' . ' ' f ,v , / ' ' > ( % ^ 7<?f 2. SA M PLE NUM B ER I 6. DISTRICT OR DIVISION / ~ S y * " / '< s r . . 7 ^ -- 8. NET CONTENTS | [n o t a pp l ic a b l e Q NOT DETERMINED u n its exam ined 0. SUMMARY OF ANA LYSIS 1 1DECLARED AMOUNT FOUND. % OF DECLARED 9. La b e l in g | | ORIGINALlS) SUBMITTED . _____________ C O PI E S S U B M I T T E D | | NONE 7^ x' f .. / Cif f ' i , S) / Cy" ? f(ft ' y / ~ <3 s<3o/ / / s.y c y o ' c / y s d if. y // 1 t, j/ Wti* c. f* /* CO ' L -*/ w / c sf / m / -V / '/< / :-% i // ' . ' /' // " /"// -C r & - / s i -iy f / ? y y / < / j ' & , / f 6 ?j T ' (*) " (3 / 11. R E S E RV E SA M P LE 12. D A T E REPORTED 15. PROGRAM DATA FD FORM 431 (8/72) 13a. a n a l y s t ^ ; N a m e / f " hKi \ ' / i 1 A y .;< O P E R A TIO N a / dcc no A C T I Vi TY NO. LOO TF S P R E V I O U S E D I T I O N IS O B S O L E T E . 13b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED b. DA TE M E T H O D (C h e c k no m ore th e n tw o ) ( A ) M A C R O S C O P I C ( M ) | i | Ml C R O S C O P I C ( X ) X . R A Y ( F ) [ | FI E L D E X A M (P) PHY EXAM rBJ I | B A C T ( O ) \ |ORGAN ( C) O CH EM (N ) Q w / O A N A L (L ) BIO GPO 934-261 G P O 934-26? ANALYST WORK SHEET 3. S EALS IN T A C T f~1 B R O K E N I I NONE 7. DESCR IPTION OF SAMPLE 1. P R O D U C T 4, D A T E R E C D S. R E C E I V E D F R O M /\ 2. S A M P L E N UM BER 6. D IS TR IC T OR DIVISION 8. NET CON TENTS I I NOT APPLICABLE ] n OT DETERMINED UNI TS EXAMIN ED 50. S U M M A R Y O F A N A L Y S IS D ECL A RE D/UN! T. AMOUNT FOUND % OF DECLARED 9. LABEL ING | j O Rl GI N A L ( S ) S U B M I T T E D | | ________________ C O P I E S S U B M I T T E D | | NONE 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13a. A N A L Y S T fe J NAME /ll 15. PROGRAM D A T A PMS NO. PROBLEM OP ERA TION H I A / D C C NO A C TI VI T Y NO. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . 13b. NUMBER 13c. PC 14. METHOD/ CACULAT I ON i CHECK M E T H O D (C he ck no more than tw o) (A ) M A C R O S C O P I C (M) ' M I C R O S C O P I C (X ) X . - R A Y (F) | | FI E L D E X A M (P ) P H Y E X A M (B ) Q3I B A C T (O ) I O R G A N ( C) CHEM (N ) Q W / O A N A L ( L ) BIO PAGE O F PAGES. ANALYST WORK SHEET 3. S E A L S I I IN T A C T [PH BR O K EN I I NONE 7. D ESCRIPTION OF SAM PLE 1. P R O D U C T / 4. D A T E R E C D 5. R E C E I V E D FR O M 2. S A M P L E N UMBER / 6. D IS TR IC T OR DIVISION 8. NET CON TENTS NOT APPLICABLE n o t d eter m in ed UNI TS EXAMIN ED 10. S U M M A R Y OF A N A L Y S IS DECL A RED/UN1T. AMOUNT FOUND X O F DECLA RED . 9. label ing | | ORI GINALIS) SU BM IT T E D | | _____________________ C O P I E S S U B M I T T E D | | NONE 11. R E S E R V E S A M P L E 12. D A T E REPORTED ,/ /7 13a. A N A L Y S T ( b) N A M E 15. PROGRAM D A T A MS, JR OB L E Y OPERATION H IA /D C C NO. A C TI VI T Y NO. FD FORM 431 (5/73) P R E V I O U S E D I T I O N IS O B S O L E T E . .13b. N U M B E R 13c. PC |1 4, METHOD/ CACULA- TION CHECK b. DA TE M E T H O D ( C heck no more then tw o) (A ) M A C R O S C O P I C (M) ''M IC R O S C O P IC (X ) X . - R A Y (F ) | | FI E L D EX AM (P ) PH Y EXA M ( B ) \ | B A C T (O ) I |p R GAN (C) CHEM (N) Q W / O ANAL (L ) BIO PAGE O F PAGES. A N A LY S T WORK SHEET 3. SEALS l_J INTACT broken P I NONE 7. DESCRIPTION OF SAMPLE PRODUCT 4. DATE RECO v /i - ( 5. R E C E IV E D FROM 7 - y ___C - P 2. S A M P L E N U M B E R 6. D IS T R IC T OR DIVISION 8. NET con tents Q not a ppl ic a b l e n o t d eter m in ed (U N IT S exam ined 1C. S U M M A R Y O F A N A L Y S I S 1 I DECLARED AMOUNT FOUND, , %OF DECLARED 0. Label in g [ 1 ORIGINAHS) SUBMITTED COPIES SUBMITTED 1 1NONE & yi w t ,J C " ' C- y l J L " cn a ' * c ) , , " ' * o '' , ' /o c` 7 r ;7 -- / y r c_ f ' ' i. f `c ', i/ * -f~ 1 /1 ' - 7 'A - ... f7 S' 7 / / ( n . . 1, *S /v ' ) L*J J r' ' V / c. / / It. RESERVE SAMPLE 12. D A T E REPORTED 13a. A N A LY S T (e) NAME /. / f / '/ 13b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED 15, PROGRAM D A T A EJiJ.EJ4 OP ERA TION A / D C C NO ACTI VITY NO. OF kOTS FD FORM 431 (8/72) P R E V I O U S E D IT IO N IS O B S O L E T E . M E T H O D (C h e ck no more than tw o) (A ) M A C R O S C O P I C (M ) ( ' M I C R O S C O P I C (X ) X . - R A Y (F ) I I FI E L D E X AM (P) P H Y EXAM ( " B ; Q b A C T ( O ) [~ | p R G AN (C ) C H E M (N) W / O A N A L (L ) BIO GPO 934-261 FD FORM 431 (8/72) P R E V IO U S ED ITIO N IS O B S O L E T E . GPO 9 3 4-26? FD FORM 431 (5/73) P R E V I O U S E D I T I O N IS O B S O L E T E . PAGE O F PAGES. ANALYST WORK SHEET 3. SEALS 1__ ) I N T A C T [BR O K EN I 1N O N E 7. DESCRIPTION OF SAMPLE ' . PRODUCT /: 4. D A T E RECD , ... 5. RECEIVED FROM -* 2. S A M P LE NUMBER ' "} 6. D IS TR IC T OR DIVISION 8. NET CON- TENTS n ot a ppl ic a b l e [ ] n ot d eter m in ed UNI TS EXAMIN ED 10. SU M M AR Y O F A N A L Y S IS D E C L A R E D /U N IT . AMOUNT FOUND 7. O F D E C L A R E D 9. LABEL ING ORIGINAL(S) SUBMITTED | | _____________________ C O P I E S S U B M I T T E D | | NONE / ' C. / (, 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13a. A N A L Y S T (a) NAME 15. PROGRAM D A T A EM.S. PROB LE Y OPERATION HIA/DC C NO A C T I VI T Y NO. FD FORM 431 (5/73) P R E V I O U S E D I T I O N IS O B S O L E T E . 13b. NUMBER 13c. PC 1. METHOD/ CACULA- T I ON I CHECK b. DATE M E T H O D (C he ck no more than tw o) (A ) M A C R O S C O P I C (M ) [ ' M I C R O S C O P I C (X ) H I X.-RAY (F ) F I E L D EXAM (P ) PHY EXAM ( B J Q b A C T (O ) I |p R G AN (C) [ C H E M (N) ( w / O A N A L ( L ) [ BIO PAGE PAGES. r A N A LY S T WORK SHEET I 3. S E A L S f ' ] INTACT BROKEN NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T 4. D A T E R E C D -* / '. 5. R E C E IV E D FROM / TT SAMPLE NUMBER .. J- I 16. D I S T R I C T OR D IV IS I O N ;~ ~ s ,/4 ^ -------------------------------- --- -- -- . e. NET CON TENTS r~) n o t a p p l ic a b l e n o t d eter m in ed u n it s exam ined I I DECLARED , AMOUNT FOUND, O F D E C L A R E D . __ to. SUMMARY OF ANALYSIS SBaMi on 3. La b e l in g ORIGINALISl SUBMITTED I I ________________ _ ,, ,, C O P I E S S U B M I T T E D I I N ON E /, y (. ! / u / 11. R E S E R V E S A M P L E 12, D A T E REPORTED 13s. ANALYST^; NAME 13b. NUMBER 13c. PC 14. CALCULA TIONS CHECKED 15. PROGRAM D A T A EMSJi j , . . .f R O B L E i ^ OP ERATION H I A / D C C NO A C T t VI T Y NO. OF lots FD FORM 431 (8/72) P R E V I O U S EDITION tS O B S O L E T E . M E T H O D (C h e c k n o more then tw o) (A ) m a c r o s c o p i c (M) m i c r o s c o p i c (X ) X..RAY (F) F I E L D EXAM (P) PH Y EXAM (B) ( BAC T ( O ) I ORGAN (C ) CHEM (N ) w/ o A N A L (L ) BIO GPO 934-261 1. P R O D U C T ANALYST WORK SHEET / 3. S E A L S INTACT ; Q 3 BROKEN j I NONE 7. D E S C R IP T IO N O F SAM P LE 4. D A T E R E C D , ' , / 2. S A M P L E N U M B E R . ' ***" ,i t"* ^ 5. R E C E IV E D FROM 6. D IS T R IC T OR DIVISION ( n o t APPLICABLE ( n o t d eter m in ed UNIT5 EXAMINED 10. S U M M A R Y O F A N A L Y S IS i 1DECLARED AMOUNT FOUND % OF DECLARED _ S. La b e l in g ) ORI GINAL(S) S U B M IT T E D | l ______________________ C O P I E S S U B M I T T E D | l NONE A / W 'l U / /' 11. R E S E R V E S A M P L E 12. D A T E REPORTED / 13s. A N A LYSTfs; NAME 13b . N U M B E R 13c. PC 14. CALCULA / TIONS CHECKED 15, PROGRAM D A T A M R . M i L ____ P fl.f l 3.F E M 1. 2. OPERATION H IA /O C C NO. ACTIVITY NO. OF _. OT S HOURS FD FORM 431 (8/72) P R E V I O U S E D IT I O N IS O B S O L E T E . M ETH O D (C he ck no more then tw o) (A ) M A C R O S C O P I C (M) r n * d f C R O S C O P 1 C (X ) X .- R A Y (F) | | FI E L D E X A M (P ) P H Y E X A M f B ) Q B A C T ( O) I |p R G A N (C ) C H E M (N) Q w / O A N A L (L ) B I O GPO 934-261  A N A L Y S T WORK SH EE T 3. S E A L S IN TAC T ('BR O K EN | | NONE 7. DESCR IPTION OP SAMPLE 1. P R O D U C T j 4. D A T E R E C D 5. R E C E IV E D FR OM 2. SAMPLE NUMBER 6. D IS TR IC T OR DIVISION Ml 8. 1 1 N O T A P P L I C A B L E NET : CON- j 1N O T D E T E R M I N ED . .. ... ..TENTS UNI TS EXAMIN ED -- 10. SU M M ARY OF A N A LY S IS DECL A R E D /U N IT AMOUNT FOUND % OF DECLARED / '/ Jl) , / c C ' f~ < ` : ^ ,7 /4 7 C S /e t t ' / T h * 9. LABEL- ING Q o r i g i n a l (s ) s u b m i t t e d [ I _____________________ _ C O P I E S S U B M I T T E D | | NONE " r ? - 1 1. R E S E R V E S A M P L E u12. D A T E REPORTED / 77 15. PROGRAM D ATA JPM&. . H. P 1. FD FORM 431 (5/73) 13 e. A N A L Y S T ^ ; N A M E O P E R A Tl O n T H I A / D C C NO, A C Tl VI T Y NO. P R E V I O U S E D IT I O N IS O B S O L E T E . 1/3 b . N U M B E R 13c. PC u . METHOD/ CACULAT I ON ! CHECK M E T H O D (C h e ck no m o r e then tw o) (A) m a c r o s c o p ic (M) ' m i c r o s c o p i c (X ) Q X.-RAY (F ) | | FI E L D E X A M (P) P H Y E X A M ( B J Q b a C T (O) I [ O R G A N (C) C H E M (N ) Q w / O A N A L (L ) BIO PAGE OF PAGES. ANALYST WORK SHEET 3. S EALS [_J IN T A C T 0 BROKEN 1 1N O N E 7. D ESCRIPTION OF SAMPLE 1. P R O D U C T ; --'S 4. D A T E R E C D / / . -- ) ,- 5. R E C E IV E D FROM /Z 2. S A M P LE NUMBER y O v3 6. D IS TR IC T OR DIVISION 8. NET CON- TENTS n o t a p p l ic a b l e n o t d e t e r m in e d U N I TS E X AMI N ED 10. SU M M ARY OF A N A L Y S IS D E C L A R E D /U N I T. AMOUNT FOUND % OF DECLARED. 9. LABEL ING O RIG IN A LISI S U B M ITTE D | | ________________________C O P I E S S U B M I T T E D | 1NONE <Ss - */ 5- m /" . ( 1' ( J / / - / / 1 s / 'V ~ cZ/o-f / c / 7 * r? 11. R E S E R V E S A M P L E 12. D A T E REPORTED t V7 L 13a. A N A L Y S T ^ ; NAME 15. PRO G RAM D A T A PROBLEM OPERATION HlA/PC C NO, ACTIVI TY FD FORM 431 (5/73) P R E V I O U S E D I T I O N IS O B S O L E T E . b. NUMBER 13c, PC 14. METHOD/ CACULA- T I ON : CHECK b. DATE M E T H O D (C h e c k no m ote than tw o) (A ) M A C R O S C O P I C (M) l ^ T M l C R O S C O P I C (X ) [ 7 ] X . - R A Y (F) | | FI E L D E X A M (P ) P H Y E X A M (B ) B A C T (O) j | O R G A N (C) C H E M (N ) 0 ] W / O A N A L (L ) [ 0 B I O PAGE PAGES. ANALYST WORK SHEET 3. S E A L S I 1 IN T A C T 3 BROKEN I INONE 7. DESCRIPTION OF SAMPLE t. PRODUCT 4. D A T E R E C D ., t" 5. R E C E IV E D FROM / r - / >- , 5 . 2. S A M P LE NUMBER 6. D IS TR IC T OR DIVISION 777 8. NET CON TENTS 771 n o t A P P L I C A B L E 77] N O T d e t e r m i n e d UNI TS E X AMI N ED to. SUMMARY OF ANALYSIS D ECL A R ED/UN1 T. AMOUNT FOUND % O F DE CLA RED . 9. LABEL ING 77] R l G I N A L ( S ) S U B M I T T E D I I ____________________ _ C O P I E S S U B M I T T E D I 1NONE ' / a /c rr fc ` / C Y ( a- )r i/ o \////> 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13a. A N A LY S T fsJ NAME 15. PROGRAM D A T A PR O BLEN / O P E RA T I O N H I A / D C C NO A C T I VI TY NO. OF uOT S FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . 13b. NUMBER 13c. PC 14. METHOD/ CACULAT ION ! CHECK M E T H O D (C h e ck no more then tw o) (A ) ( 7 7 M A C R O S C O P I C (M) PT~M) C R O S C O P I C ( X ) " X - R A Y ( F ) | | FI E L D E X A M (P) 7 7 P H Y E X A M f B ; [ 7 7 B A C T (O) | O R G A N (C ) (77 C H E M (N ) ( 7 7 W / 0 A N A L ( L ) (77 B, PAGE O F PAGES. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O F PAGES. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O E PAGES. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O F PAGES. 11. P R O D U C T ANALYST WORK SHEET 3. S E A L S INTACT BROKEN I INONE 7. D ESCRIPTION OF SAMPLE |4. DATE RECD 5. R E C E I V E D FROM / '/ s i/ / A , . . . J L ___ c - ' - v c 2. S A M P L E N U M B E R 6. D IS TR IC T OR DIVISION NOT APPLI CABLE NOT DETERMINED UNI TS EXAMIN ED 10. SU M M AR Y O F A N A L Y S IS D E C L A R E D / U N 1T AMOUNT FOUND % O F DE CLA RED 9. LABEL ING ) O Rl GIN A L(S) S U B M I T T E D _______ ______________ C O P I E S S U B M I T T E D | | N ON E ( / I K/ v ? <y) \ > / < c . ? /* A /.O ! // J / ' r l , / /-i X / <7 s '* - ' s / ~ C 0 % 'Y .. / L . W i /. <' / ' ' - V. / Z1 c / ' /A c <?/" u-/ V'l. c<rf- /A r'/i A - a / <5 e/-'v}fe,n,-y/t7?&7-7 c /' /' c-( S.T /AM / : / sk / , **-^3 / 1 1. R E S E R V E S A M P L E 12. D A T E REPORTED ;r :X ;v 15. PROGRAM D A T A 1 3 b . ANA'Dy s t W NAME V/ / -- w/ EM S. N O . PROBLEM a / dcc n o . 2. / ,/ 71 ' AC T IVI TY NO . FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . 13b. NUMBER 13c . P C 14 METHOD/ CACULA- T I ON b. D A TE CHECK M E T H O D ( C h e c k no m o re th a n tw o ) (A ) M A C R O S C O P I C (M) ( ' t v U C R O S C O P I c (X ) x . - R A Y ( F ) | | FI E L D E X A M (P) PHY EXAM ( B ) B A C T ( GO I |p R GA N (C ) CHEM (N ) w / O A N A L (L ) BIO ANALYST WORK SHEET i 3. S E A L S (33 B R O K E N ! INTACT [ 1NONE 7. DESCR IPTION OF SAMPLE 1. P R O D U C T V______ - y , ,____________ Ad 4. D A T E R E C D 5. R E C E IV E D FROM 2. S A M P LE NUMBEIR __ 6. D IS TR IC T OR DIVISION / 'A c x x . m . , cJ. ^ D jc D l L l. y <*'- ' NET CON TENTS Q NOT APPLICABLE Q 3 NOT DETERMINED U N I T S E X AMI N E D 10. S U M M A R Y O F A N A L Y S I S DECLA RE D/U N IT AMOUNT FOUND % OF DECLARED 9. LABEL ING [33! O Rl GI N A L ( S ) S U B M I T T E D | | ______________________C O P I E S S U B M I T T E D j H N ON E CP; O' C j 1/ /" AtaD7<c., A"* ' / > ? L4 /> C?' / <J Y " /70- / />, , Y/fj a v.- . . - ( / ' A / a e. /? /c- .D-/// I 7 a /~A/ -c ,,_. / / // yV-/ / r s A ' c / n // a: A / *3 C < ? /" / >'? c. / / A i -7 - 7 / s ( <0 /" ) , c/ / A ./ / P ? 7 ' l - C -C; C?( - 7 A T / / >(?/ < 0 / / . - .fl ... / 11. R E S E R V E S A M P L E 12. D A T E REPORTED if " 7f / 15. PROGRAM D A T A 13a. AN AYSTfs_) NAME \ rJ->* / ,- . : // *. OP ERATION H I A / D C C NO 13b. N UMBER 13c. PC 14. METHOD/ Y X/' CACULA- T l ON b. DATE I CHECK A C T I VI T Y NO . OF LOTS HOURS M E T H O D (C h e ck no m ore than tw o) (A) M A C R O S C O P I C (M) C R O SC O P IC (X ) X. -RAY (F ) | | FI E L D E X A M (P) P H Y E X A M / S / 1 3 3 B A C T (O) I ORG AN (C ) ( 3 3 C H E M (TV) [ 3 3 W / 0 A N A L ( L ) 8 1 0 FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O F PAGES. A NAL YS T WORK SHEET 1 3. SEALS INTACT [ 3 ^ P KEN 1 1NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T b --? - : 4. D A T E R E C D } . i* 'i 5. r e c e Tv e d f r o m L /A 0 2. S A M P LE NU MB E R / - . S 'r 6. D IS TR IC T OR DIVISION - 1- - 8. NET CON- TENTS I I NOT APPLICABLE I I NOT DETERMINED UNI TS E X AMIN E D 10. SU MMARY O F A N A L Y S IS D ECL A RED/UNIT AMOUNT FOUND % O F DECLA RED 9. LABEL- ING Q ] ORI GINAL(S) S U B M IT T E D | | ____________________ C O P I E S S U B M I T T E D | | NONE / J' A. /, S / C- " > S3 J/ S om S) J -L --- / v '3 ('s'. / ,/ ^ /r-tfi-t n/ / ' /Z-MA- ' -- y /yc C- C ; . /!< *_ - / '3 y ^ */ l/ / / A <- /:' &A- ~/ / `' i /rc>' / ' : 1 Ve, ) !X/ A a. \ -r '/: / ' '-S-.'v * ** : >/ /-< r% 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13 a. A N A L Y S T ^ ; N AME i/ / //' rl f /J ' / /^ (A 15. PR O G R AM D A T A OP E RA T IO N H I A / D C C NO, V- / 13b. N U M B E R |l 3c. PC . a. BY ' METHOD/ ... C A C U L A - / TION b. D A T E 1 CHECK ACTI VITY iQT S HOURS 1 M E T H O D (C h e ck no more than tw o) (A ) Q m a c r o s c o p i c (m ) P ^ m t c r o s c o p i c (X ) X . - R A Y (F ) FI E L D E X A M (P) PH Y EX AM ( B / C I Ib ACT (O) I ORGAN (C) C H E M (N ) Q w / O A N A L ( L ) BIO FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE OF PAGES. ANALYST WORK SHEET 3. S E A L S I I IN TAC T n Broken I I NONE 7. DESCRIPTION OF SAMPLE t. p r o d u c t ' _________ L - e 4. D A T E R EC D 5. R E C E IV E D FROM c /A 2. S A M P LE NUMBER 6. D IS TR IC T OR DIVISION 8. NET CON TENTS [A] n o t a p p l i c a b l e I | NOT DETERMINED UNITS EXAMINED 10. SU M M ARY OF A N A L Y S IS D E C L A R E D /U N IT . AMOUNT FOUND % O F DE CLA RED 9. LABEL ING 1 | ORI GINAL(S) S U B M IT T E D | | _____________________ C O P I E S S U B M I T T E D | | N ONE / 7 - l/c * ~ > c&h-CH Or~-C ' / - O ' "2 d) J A 7 Sr -^ ,, / ty ' a ^ 7 ' : t r \ a c. C / \ /( .,/ -A j -? / A o : - e // F c- r i / d A ' / A A / , <\ A ^ -, . y y ; ^ ' -v V a > / -- A A 11. R E S E R V E S A M P L E 12. D A T E REPORTED L i f t/ 13a. A N A L Y S T ^ ) NAME n: 15. P R O G R A M D A T A PROBLEM OP ERA TION HIA/DCCNO 13b. NUMBER 13c. PC 14. METHOD/ CACULA- 7 - T I ON CHECK A C T IVI TY NO. OTS HOURS M E T H O D (C he ck no more than tw o) (A ) M A C R O S C O P I C (M) [ j g - M r C R O S C O P I C (X ) [ 7 ] X r R A Y (F ) l | FI E L D E X A M (P) Q P H Y E X A M CB; B A C T (O ) I O R G A N (C) C H E M (N ) Q w / O A N A L ( L ) BIO FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O F PAGES. ANALYST WORK SHEET 3. SEALS in t a c t Q BROKEN O NONE T, D E S C R IP T IO N OP S A M P L E 1. PR O D U C T 4. D A T E RECO __ > iiir,iiiiii--aBBgBaa-- PWTrwuicsssfigBSi 2, SAM P LE N U M BER S. R E C E I V E D F R O M / 6. D IS T R IC T OR DIVISION , y , U-- J -- '? ' / ~ V X r M - y 8. NET CON TENTS Q k OT A PPU C A B L E {N O T DETERMINED Q u N t T S EXAMINED tiS6UfcJB3ieaiS*6: to, SUMMARY OF ANALYSIS r~~] D E C L A R E D AMOUNT FOUND, O F D E C L A R E D ... 2*r.-^ ?=ir-ii=rac-r S. La b e l IMG [ 1 ORI GINA LIS) S U B M I T T E D [ j ____ _______ ________ C O P I E S S U B M I T T E D | | NONE / /' <** , / ..V jt ! V ,., Cf -- "7 f i . f ^ ' '- ,7 C c r $ 4 S*i c4- . :; ; i ' / ' L. / / / .. a - : / ' //'^ - " L -i '.-"I J ' v z; / '/ ' **- ... 7- v i t 1 (.r V C -V iy so r S i'c 1 / ' v /, ( Ct c -v . , . //^ /6 A v .< ?A v 11. R E S E R V E S A M P L E \ 12. D A T E REPORTED 13e. A N A L Y S T f s ; NAME.) L - _ X . A l /-:.V / ; 13b. NUMBER 13c. PC T aT " CALCULA TIONS CHECKED . BY b. DATE 15, PROGRAM DATA I M S_K *. 1 * 2. P8 P 6tE M 3iL 1 FD FORM 431 (8/72) l/ OP E RA TION H a/ dcc no. ACTIVITY NoOr . , QTS HOURS P R E V I O U S E D IT I O N IS O B S O L E T E . M E T H O D (C he ck no more than tw o) (A ) [ ] ] M A C R O S C O P I C (M ) Q M I C R O S C O P I C (X ) X . R A Y (F) | | F I E L D EXAM (P ) P H Y e x a m ( B ) Q b a c t (O ) I [ORGAN (C ) C H E M (N ) w / O A N A L (L ) i I BIO GP 0 934-261 ANALYST WORK SHEET 3. SEALS 1 I INTACT BROKEN P I NONE 7. DESCRIPTION OF SAMPLE i. PRODUCT 4. DATE RECO 5. R EC EIVED FROM 2. S A M P L E N UM BER 6. D IS TR IC T OR DIVISION fSNET CON TENTS r~i N O T A P P L I C A B L E NOT DETERMINED f~l u n it s E xamined to . SUMMARY OF A N A LY S IS I I DECLARED AMOUNT FOUND, % O F D E C L A R E D ___ iS. \LABEL ING Q ORIGINAL(S) SUBMITTED | 1______________ COPIES SUBMITTED | | NONE 11. R E S E R V E SA M P LE 12. D A T E REPORTED 13s. A N A L Y S T fe) NAME 13b. 'NUMBER 13c. PC 14. CALCULA TIONS CHECKED 15, PROGRAM D A TA EMA OPERATION H I A / D C C NO ACTIVI TY NO. OF *OTS FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . M E T H O D (C h e ck no more then tw o) (A ) Q M A C R O S C O P I C (M ) f 1 Ml C R O S C O P I C (X ) X.-RAY (F ) F I E L D EXAM ()( P ) Q ] P H Y E X A M ( B J [ ^ B A C T [ZHRGAN (C ) C H E M (N) Q w / O A N A L (L ) BIO GPO 9 34-261 ; ANALYST WORK SHEET i 3. SEALS INTACT BROKEN NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T 4. D A T E R E C O 5. R E C E IV E D FROM 2. SAMPLE NUMBER 6. DISTRICT OR DIVISION e. NET CON TENTS r~l NOT APPUC ABLE {3! NOT d e t e r m in e d Q u n it s exa m in ed 10. SUMMARY OF ANALYSIS I I DECLARED AMOUNT FOUND. % O F D E C L A R E D . __ 9* La b e l in g Q ORIGINAL(S) SUBMITTED | ) _____________________ C O P I E S S U B M I T T E D | | NONE u 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13a. A N A L Y S T ^ ; NAME 13b. 'Nu m b e r 13c. PC 14. CALCULA TIONS CHECKED b. D A T E 15, PROGRAM DATA MSU. J R PBLM OPERATION n A C T I VI T Y NO. OF OTS HOURS FD FORM 431 (8/72) P R E V I O U S E D I T I O N IS O B S O L E T E . M E T H O D (C h e c k no more then tw o) (A ) M A C R O S C O P I C (M) M I C R O S C O P I C (X ) Q X.-RAY (F ) | | FI E L D E X AM (P) P H Y EXAM C B ; Q b A C T ( O ) I |P R G AN (C ) C H E M (N) Q w / O A N A L ( L ) BIO GPO 934-261 ANALYST WORK SHEET '3 . S E A L S f I INTACT Qfj BROKEN I I NONE 7 . DESCRIPTION OF SAMPLE 1. P R O D U C T I S tA . D A T E R E C D 5. R E C E IV E D FROM ` Y, '~ ? / 2. S A M P LE NUMBER ,6. D I S T R I C T OR D I V I S I O N ,8. NET CON- TENTS f 1 NOT A PPLICABLE | | NOT DETERMINED UNITS EXAMINED 10. SU M M AR Y OF A N A L Y S IS D E CL A R E D/U N IT AMOUNT FOUND % OF DECLARED 9. LABEL- ING ( O RI GI N A L ( S ) S U B M I T T E D | [ ________________ _ _ _ _ C O P I E S S U B M I T T E D 1 1N ONE A l />? / r. f2 *3 __ s' ? cP < (-sr'/ <\ .(/-) 1/?. (. - U 7 2- ~ / / / ' / i : '; .< , l A. f./ / / ' / / / // / - ; . -, s - C j/tfr ' / < - K'O - , ' ' a^ 1 '/ -** ^ * 1 / , -A * -- * . . / ( / o (1 / / ' i v * / 4 7 /' /fr ` i/ . S i / 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13a. ANI LYSTfa) NAME 7 _____ y ' / / \ b . N U M BER 13c. PC 14. a. BY / METHOD/ CACLA- T 1ON 1 CHECK b. DATE 15. PR O G R AM D A T A ^ ,PMS NO. \. 2. PROBLEM OP ERA TION H IA/DCC , - r r , ..... .......... NO ..... A C T I V I TY NO. ,OTS HOURS L iJ T FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . (A ) M A C R O S C O P I C (M) [ ' M I C R O S C O P I C (X) J x . - R A Y (F ) | | FI E L D E X A M (P) PH Y EXAM ( S J Q b A C T (O) O R G A N (C) C H E M (N ) Q W / O A N A L ( L ) BIO PAGE OF PAGES. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O F PAGES. FD FORM 431 (5/73) P R E V I O U S E D I T I O N IS O B S O L E T E . PAGE O F PAGES. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O F PAGES. ANALYST WORK SHEET 3. S E A L S INTACT T b ROKEN [ 1NONE 7. D ESCR IPTIO N OP SAM PLE .2SE3 -- ... U PRODUCT r___- . u g y n s r . - - ; - g y r . ' C e s 3g^i : - ' , c - ' 4. D A T E RECD 5. R E C E IV E D FROM S? -- s e e s :------ --- *** 2. S A M P L E NUMBER _ 6. D IS T R IC T OR DIVISION 8. NET CON TENTS ) NOT APPLICABLE NOT DETERMINED UNITS EXAMIN ED 10. S U M M A R Y OF A N A L Y S IS D ECL A RED/UN1 T Am o u n t f o u n d % OF DECLARED 9. LABEL ING | | ORI GINA LIS) S U B M I T T E D | 1 _____________________ C O P I E S S U B M I T T E D 1 | NONE / 6O / 'L v 'v c / 7 fie ls t / U ;< s a.</r& X*f >c/ e S' r / / 7 c * J J ; . a.7.. tt . 7 , . . /<? ` I I i Ci -/ V /, /" / / / 0 y* r ') ) ^ 7 ( (t i t c A es U n -k / j * f X 7l / .i^ c ^ t i f f # - ' ' /,w # ^ / 7 - j / xT r ! < 8 ta & /x r r c , ( & * & / * & / *1 ^ .& ) / ATo/fro1t /j A / A j\St. / / / y/ ~ c f . - e u S / `7 ^ ^ 11. R E S E R V E S A M P L E 12. D A T E REPORTED 7v 'y 15. PR O G R AM D A T A 13a. A N ^L-Y S T A bPNAME 7 I U/ OP ERATION ELLS. -EL PROB LE M h i a / d c c NO. 7/ A C T I VI T Y NO. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . 1 3c . PC 14. a. by METHOD/ CACULA- TION 1 CHECK b. DATE M E T H O D (C he ck no more than tw o) (A ) m a c r o s c o p i c ("m ; P ^ T mi C R O S C O P I C f x ; X.-RAY f F ; ) FI E L D E X AM (P) P H Y E X A M ( " B / Q b A C T (O) I | p R G A N (C ) C H E M (TV) W / O A N A L ( L ) B I O PAGE O F PAGES. ANALYST WORK SHEET 1. P R O D U C T jL a s S 'O / 'M 2. S A M P L E N UM BER ` -y tc A / & 7 3. S E ALS 1 1IN TAC T 4. D A T E R E CO 5. R E C E IV E D FROM 6. D IS TR IC T OR DIVISION [ ^B R O K E N I 1N O N E 7. DESCRIPTION OF SAMPLE / <*( / u m - 8. n o t a p p l i c a b l e NET CON n o t d eter m in ed TENTS U N I T S E X AMI N E D to. SUMMARY OF ANALYSIS D E C L A R E D /U N IT . AMOUNT FOUND % OF DECLARED 9. LABEL ING | | ORICINAL1SI SUBM ITTED | | __________________ _ C O P I E S S U B M I T T E D | | NONE / TA /r A C C 5a A - / ? . 0 A / I 'T / -c ^ AS /O A A <?St c 3- U. 7 7 /V> A", / ' / r' O ' //y / U 0 - > 7 7 y J y / ' . c. 7 "f/7t y} -/? N r(7SO/ J/ / '.i% 1( " i! l t1 K cT. 7 . 0 S ./f ca ' c f yV `vx* f 1 >. c /^, -Sr >7^ / - - 1 1. R E S E R V E S A M P L E 12. D A T E REPORTED "7 / 'V . / /0 L /y 5. PROGRAM D A TA 13a. A N A L Y S T ( e j NAME 7 ,. A O P E RA T IO N PROBIEN HIA/DCCNO , 7 T " , 1315. N U M B E R 13 c. PJ14. METHOD/ < \ //Mt CACULA- TI ON CHECK b. D A TE ACTIVI TY NO. LOTS M E T H O D ( C h e c k no m ore th a n tw o ) __ (A ) m a c r o s c o p i c (M) T m i c r o s c o p i C (X ) x .-r a y (F ) I | FI e l d e x a m (P) P H Y EX AM f B j Q B A C T (O) I [ OR G AN (C ) C H E M (TV) Q w / O A N A L ( L ) B I O FD FORM 431 (5/73) P R E V I O U S E D I T I O N IS O B S O L E T E . PAGE O F PAGES, F D FORM 431 (5/73) P R E V I O U S E D I T I O N IS O B S O L E T E . PAGE O F PAGES. FD FORM 431 (5/73) P R E V I O U S ED IT IO N IS O B S O L E T E . PAGE O F PAGES. FD FORM 431 (5/73) P R E V I O U S E D IT I O N IS O B S O L E T E . PAGE O F PAGES.