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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 .
P A G E 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
OF
PAGES.
ANALYST WORK SHEET
3. S E A L S
I I IN TACT
I I BROKEN
I H -NON E
7. D E S C R IP TIO N OF S A M P LE
t. PRODUCT
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4. D A T E R E C D
5. R E C E IV E D FROM
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NET CON TENTS
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UNI TS EXAM IN ED
10. SUM M ARY O F A N A L Y S IS
D EC L A RED/UN IT AMOUNT FOUND % OF DECLARED.
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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 UM BER
13c . P C 14.
M ETH O D /
CACULA-
T I ON I CHECK
b. D A T E
M E T H O D (Check no more then two)
(A) M A C R O S C O P I C
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BIO
PAGE
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
OF
PAGES.
ANALYST WORK SHEET
3. S E A L S
I 1IN TACT
I I BROKEN
'N O N E
7. D E S C R IP T IO N O F S A M P L E
I. PRO D UCT
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4. D A T E R E C
5. R E C E I V E D FROM
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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
1 1N O T A P P L I C A B L E ) NOT DETERM IN ED
UNI TS EXAM IN ED
10. S U M M A R Y O F A N A L Y S I S
D E C L A R E D / U N 1T AMOUNT FOUND % OF DECLA RED
9. LA B EL-
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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 ER
1 3 c . P C 14.
M ETH O D /
CACULA-
TION ! CHECK
b. D A T E
M E T H O D (Check no more then two)
(A)
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(X ) (F)Q X - R A Y
| | FI E L D E X A M
(P) P H Y E X A M
(O)( B j Q B A C T
I |o R G A N
(C) C H E M (N) w /O A N A L (L) BIO
PAGE
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PAGES.