Document ByRB7bJMgpnJ8koREBDOmpM1o

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 T<uc p *o 4 4. D A T E R E C D 5. R E C E IV E D FROM f4 p f i t < y -9- l/ L S p - '- 15 7 ^ 1 4 4',f i f 4 ^ fi /2 / / / / 7J -- / -- l -- 2. SAM PLE NUMBER 6. D IS T R IC T OR DIVISION L 4 4 8. NET CON TENTS not a p p lic a b le n o t d eter m in ed 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. 9. LA B EL ING ORIGINAL(S) SU BM ITTED | | _____________________________ C O P I E S S U B M I T T E D I | NONE /a /c j / 44f 7 a 7-C . / */*% } i 0 .4 4 7 4 - /- < fi <> t' //w o. ^/ / f // C fii u f i / / c / if ' / so Z /U 7. . / 1 4-/71 / f i / f i -/V ?o f i / ic /1 a ( f i ' s - r t n (( 4 11. R E S E R V E S A M P L E 12. D A T E REPO RTED / I fi1 13a. A N ^ L Y S t/s^ N /iM E ^ y< fi " f ^1(* C '< 15. PR O G R A M D A T A pro blem O P E RA TIO N H I A / D C C NO. A C T I VI T Y NO . WOTS 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 (M) ^ M I C R O S C O P I C (X) (F) X . - R A Y l | FI E L D E X A M (P) P H Y E X A M (O) \( B j Q B A C T |p R G A N (C) ( L ) C H E M (TV) w / O A N A L 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 T a /c /W 4. D A T E R E C 5. R E C E I V E D FROM <2 <5> / f't - t Ml/ Q2 P z SS"! /2-7 ///7J 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- 1NG 1 | ORI GINAL(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 | 1NONE / a ,'C 3 .. Cf ) 'J / 'S o n . /< O. G/ )t J fjg r .o / - Jr/ # '/> // a n '/ c / On 0 7 / 7<L y/ n <*fic Ip C / n c f S o / f u / 7. Jt-w e /'/c .- a // Xr*S-c/" t it 11 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 e j NjAME V iC /A . ( p 1 _ t/---------- r 7 h C SC (/" 15. PRO G RAM D A T A P M S NO. PRO B LEM OP ERA TION H IA /D C C NO. A C T I VI T Y NO. OF hgT-5 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) m a cr o sco pic ( )m P T m i C R O S C O P I C (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 OF PAGES.