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2. S A M P L E N U M B E R / 7a/'C (T- ' < (... Y/ r . y> AL ? .J //s /L - 3 . J- . ^ M e* /*> f / i-,f / 7 7/ -(, "- 77c^ e / / f 6 7. 7 ho Jl / 1' t c /7 / / 1-r?' /; /( ^ 5 C?/ / < <( // 11. R E S E R V E S A M P L E 12. D A T E REPO R T ED 7V/ 13a. ^ A N A L Y S T ( s) N A M E / 15. P R O G R A M D A T A f MS NO. J. PROBLEM OP ERA TION H IA / D C C NO. 13b. N U M B E R 13c. P C 14. a. BY METHOD/ CACULA- T IO N 1 CHECK b. DA TE A C TI VI TY NO . OF LOTS HOURS METHOD (C h e c k no more th e n tw o) (A) M ACROSCOPIC (M) Q m i c r o s c o p i c (X) x .- R A Y (F) | | FI ELD EXAM (P ) PHY EXAM ( B ) [ B A C T f O ) I |pRG AN (C ) CHEM ( N ) Q w / O A NAL ( L ) I I BIO 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 II N T A C T I I BROKEN m NONE 7. D E S C R I P T I O N O F S A M P L E 1, P R O D U C T 4, D A T E R E C D J y 7 'J 5. R E C E I V E D F R O M os 2. S A M P L E N U M B E R 6. D I S T R I C T O R D IV IS IO N ?// 8 NET CON TENTS NOT A P P L I C A B L E NOT D ET ERM INED UNI TS E X AMI N ED 10. S U M M A R Y O F A N A L Y S I S DEC LA RED/UN I T AMOUNT FOUND % O F DECLA RED 9. LA BEL ING I I O RI GIN A L(S) S U B M I T T E D I I __________________________ C O P I E S SU BMI TT ED I I NONE / T & s 'c ' <- 7 1 s > O / O^ y <- G s * / 7 7 c y - S - s y - t. + rn '. 7 //) .J W ' 'z / .-/r / . / / < V /: A 7 7 / ` C /{ y / 0/ / /O r (s *" / c 7 7 / e s t y r C, ' / / v /. : - c * / "-V .> - 7 < / : / / /' /! ' & /7' T c ? / f V -C- / Q i a i $) A- ,.7 4 A l ( 7. , y , 'J f . 7 7 7 -C t V? , 7 //? c - 7/ / ? -7 <r? / A / *7/*-. r -- *s w n /-2 % ./ yy 1 1. R E S E R V E S A M P L E 12. D A T E R EPO R T ED V 'f 13a. A N A L Y S T f e ) N A M E ) v/ / /fy 15, P R O G R A M D A T A PROBLEM OP ERA TION H 1A / D C C N O . // 13b. N U M B E R 13c . P C 14. a. BY M ETH O D / CACULA- TION I CHECK b. DATE A C TI VI TY NO. OF ,OTS L~ HOURS M E T H O D (C h e c k no more than two) (A) M A C R O S C O P IC (M) Q 3 Ml c r o s c o p i c (X) X.-RAY (F) [ I FI E L D E X A M (P) PH Y E XA M r B ; B A C T CO) I ]o R G AN (C; CHEM (N) w / O A N A L (L) BIO 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. 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. S E A L S I I INTACT I I BROKEN P in o n e 7. D E S C R I P T I O N O F S A M P L E 1. P R O D U C T 4. D A T E R E C D T a 4>. 7 // S f), 5. R E C E I V E D P R O M A l / /~ 7 / J J - Q j u ./'> / 2. S A M P L E N U M B E R 6. D I S T R I C T O R D IV ISIO N / /.?J > .7/7 8. NET CON TENTS NOT A P P L I C A B L E I I NOT DETERMINED UNITS EXAMIN ED 10. S U M M A R Y O F A N A L Y S I S D E C LA R ED /U N IT . AMOUN T FOUND % OF DECLARED 9. la bel in g PZj 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 | |NONE // 4 / a/c y # r% r (r.a'i/ s<C;, / r - /?o/t -3-hi/y<</. -/y*. 1 ** -< // i fj 7/ -VV '& / / c w s ' s>f-/p'.r* /1 &C ?>*./-</ / ^S'e. r / <( / T'haii'/s'A/ c-~ // 1 1. R E S E R V E S A M P L E 12. D A T E R EPO R T ED 13 a. ^ A N A L Y S T f s ; N A M E / J / ' 7 '/ 15. P R O G R A M D A T A (/ OP ER A TION 3ROB I - E M H 1A / D C C N O . A C T I V I TY 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. P C 14. METHOD/ CACULA- Tl ON j CHECK b. DATE M ET H O D (C h ec k no more than two) (A) Q ] MACROSCOPIC ( M) F T Ml CR OSC OPI C ( X ) Q X f R A Y ( F ) | | FI E L D EXAM (P) PHY EXAM / J B ; F ] b a CT ( O ) I ORGAN ( C ) CHEM (TV) n W/, A NAL ( L ) BIO PAGE O F PAGES, ANALYST WORK SHEET 3. S E A L S I I IN TA C T I I BROKEN NO NE 7. D E S C R I P T I O N O F S A M P L E 1. P R O D U C T 7> -' 4. D A T E R E C D =) ^ 5. R E C E I V E D F R O M } ! ' -- V.15 / D 2. S A M P L E N U M B E R 6. D I S T R I C T O R D I V I S I O N 8. NET CON TENTS not a p p l ic a b l e I I N OT D E T E R M I N E D UNI TS E X AMI N ED 10. S U M M A R Y O F A N A L Y S I S D EC LA RED /U N IT. AMOUNT FOUND % OF DECLARED 9. LA BEL ING Q ORIGINALtSI SUBM ITTED | | _________________________ C O P I E S S U B M I T T E D 1 | NONE / J U y * V T /c CP LY1 P- O O se A/ * iv d- / . v' / c / S - t f / '^ r . U/' ? / V / / !a r /, ,j? /-fi A? // L-^>' *7 / * > / <- t, J/ -/ a J/ 7A( A>v>-<--s l/&*- c// / /./ A y /jt e-/y ~`C~ D m 7/0)7 ' y C- * !( h / / a 7 /V? r .. ; / y < f / - t /*<- "O , ' iJ 1 1. R E S E R V E S A M P L E 12. D A T E R EPO R T ED 13a. A N A L Y S T / ; N A M E 7. / / /\ 15. P R O G R A M D A T A f MS NO. 1. PROBLEM O PE R A T IO N H 1A / D C C N O // , 13b. N U M B E R 13c. P C 14. METHOD/ CACULA- TI ON I CHECK b. D A T E A C T I VI TY NO. ,O T S HOURS METHOD (C h e c k no more then two) (A) m a c r o s c o p ic (M) [ t j MICROSCOPIC ( X ) X.-RAY ( F ) F I E L D EXAM (P) PHY EXAM W B A C T ( O ) I [ORGAN (C ) CHEM (N ) Q W / O ANAL ( L ) BIO 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. SEALS I I BROKEN INTACT I H-NON E 7. D E S C R I P T I O N O F S A M P L E I. P R O D U C T 7^ / c PU-4 4. D A T E R E C 5. R E C E I V E D F R O M ^ ^ 7il M / 0 .3 9 - S S I 2. S A M P L E N U M B E R 6. D I S T R I C T O R D IV IS IO N 8. NET CONTENTS 1 1NOT A P P L I C A B L E NOT D ET ERM INED UNI TS E X AMI N 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/UNI T AMOUNT FOUND % OF DECLARED 9. LA BEL ING | | ORI G IN A L lS ) 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 / ct ,'C p r 4 ? '-<`7 '<00,2a /<*' /) J o . A f r A w / \a y n c o On/ f /i-Vv t-/c (e O h t c f - S o / / U 7. 7 1-C/?l f r > / -- r VS S/ ' fJ/Z C /1 // CA ' / S - Z t * A <l 11. R E S E R V E S A M P L E 12. D A T E REPO R T ED 13 e. A N A L Y S T f e J N ^ M E '0 -Z A i. ( / ' ^ 1 'i / // 15. P R O G R A M D A T A OP ER A TION M S PROBUES/ H I A / D C C NO. /V . / ./ ( c a ( I S A C T I V I TY NO. OF ,OTS 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. P C 14. METHOD/ CACULA- T l ON I CHECK b. DA TE M ET H O D (C heck no more then two) (A) M A C R O S C O P I C (M) 3 ' 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 j O B A C T (O) f | o R G A N (C) C H E M (N) Q w / O A N A L (L) B I O PAGE OF PAGES.