Document dnVQ7KR7BKb7Ky1R2z5qNqoDQ

7. D E S C R IP T IO N O F S A M P L E / La i dt JsL - L _ _ 7_ -------- y~ 6. : NET ) CON TENTS P IN O T APPLIC ABLE P I NOT DETERM INED P i u n it s e x a m in ed tO, S U M M A R Y O F A N A L Y S I S | 1D E C L A R E D ________r_______________________ AMOUNT FOUND % OF D E C L A R E D ........... ................ 9o La bel- sng ^zasz&czXassz P ] ORI G IN A L ( S ) S U B M I T T E D (~~~1 COPIES SUBMITTED f I NONE / 7C c. / / cni y / c -- `y 2 / ._, `I / 7 ^ ' si 3 ,0 -r-^ so/ _ K i- JJg t M a / i/ ^ ... ( Lt ^ / / / A ?. /? O A c / / x V <r / ( s /'l / V r / r * h C s / ' t r i / > / y / / // / / / ~ t/-ri > / 3 7 ~C ^ i/ V /\ A y / ft A s' A / * * * * C J 1t. R E S E R V E S A M P L E 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 . METHOD (C heck no more than two) (A ) Q M A C R O S C O P IC (M) P T m i C R O S C O P I C (X) X .* R A Y (F) 1 I FI ELD EXAM ( P ) Q P H Y E X A M (B ) I | B A C T ( O) I |p R G A N (C) C H EM (TV) P j w / O A N A L ( L ) BIO G P 0 934-268 ANALYST WORK SHEET 3. S E A L S 0 BRO KEN r C] I N T A C T n NONE 7. D E S C R IP T IO 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 'V /A <; ' r .- S. R E C E IV E D FROM -' 2. S A M P L E N U M B E R .... .6. D IS T R IC T O R D IV IS IO N / .' ' /{( C~ / B. NET CON TENTS r i NOT A P P L IC A B L E Q n o t DETERMINED f~~i UNI TS E X A M I N E D 10. S U M M A R Y O F A N A L Y S IS I !/ / ! I DECLARED AMOUNT POUND, % O P D E C L A R E D ^ ___ "V / /c 'rf ?: ( ' / / ( o /. 7 rie/Xc 9. La bel in g O RIGINALS) SUBMITTED | ] __________________________C O P I E S S U B M I T T E D f |NONE J / '/ O > / / c a - h " f~A-'S >c./ c xs7*-e s /~ /(V "-* c. 11. R E S E R V E S A M P L E 12. D A T E REPO RTED 13a. A N A L Y S T ^ ; N A M E 13b. N U M B E R 13c. PC M. CALCULA TIO NS CHECKED 15, P R O G R A M D A T A E M fiJifi* PROBLEM OP E R A TION H A / P C C NO A C Tl VI TY NO. or ,QT S 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 . METHOD ( C h e c k no more than 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 ) O X . - R A Y (F) | | FI E L D EXAM (P) O pHY EXAM (B) [ B A C T I'O) I ORGAN (C ) 0 CHEM (N) O / O A N A L ( L ) BIO G P O 934-261 ANALYST WORK SH iET 3. S E A L S rp ^ RO K EN rn INTACT r~l 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 ' /V- ; v* / 5. R E C E I V E D F R O M 2. S A M P L E N U M B E R 6. D IS T R IC T O R D IV IS IO N s' : 8. NET CON ' TENTS H n OT A P P L I C A B L E { NOT DETERMINED UNITS EXAMINED to, SU M M A R Y OF A N A L Y S IS [ 1DECLARED AMOUNT POUND, % OP D EC L A R ED ' j` C t S. La bel* ! 1NG 1 I ORIGINAUS) SUBMITTED n. COPIES SUBMITTED 1 1N O N E j, 1' / / Z'/ , / L' 7'<*A <-* // / ji$ r < it. I - C tt. R ESER V E SA M PLE 12. D A T E REPO RTED 13c. A N A L y S T fe ^ N A M E 1/ 7*/ fo b . N U M B E R 113c. P C lU . CALCULA TIO NS CHECKED b. D A T E 15, P R O G R A M D A T A EMA.M.R. s e a r i -e h OP ERA TION rr H A / D C C NO. A C T I VI TY NO, OF LOTS 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 . METHOD ( C h e c k no more then two) (A ) Q MACROSCOPIC (M) | | MICROSCOPIC ( X ) X^RAY (F) | | F I E L D EXAM (P ) PHY EXAM ( B J Q b A C T ( O ) | |p R GAN (C ) CHEM (N) Q W / O A N AL (L ) BIO 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 . GP 0 9 3 4 . 26f ANALYST WORK SHEET 3. S E A L S IN TA C T r~Pf B R O K E N 1 1N O N E 7. D E S C R IP T IO 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 5. R E C E I V E D Ff^OM - V : / ;k ^ t3 7^1 ry So 2. S A M P L E N U M B E R o 6. D IS T R IC T OR D IV ISIO N //' . r-/-'-- // ^ / .6. NET CON TEN TS Q not a p p l ic a b l e Q not d e t e r m in e d u n it s E xa m in ed to. SU M M A R Y O F A N A L Y S IS 1 I DECLARED AMOUNT FOUND, % OF D EC LA RED K/ 9 La bel in g 1 1O RIG IN AL (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 i/* U f K) /7 ; i/ /: / / '- // v ^J /( y <X 7; * , ' r `- V - n S- S t h <- <~r /h c. c ' V-7 /a-// 5 L "/ It. R ESERV E SAM PLE 12. D A T E REPO RTED 13s. A N A L Y S T f s ; N A M E ; ;/ / , 13b. NUMBER 13c. PC U. CALCULA * / TIO NS CHECKED T" program data MS PROBLEM OP E R A T I O N I H IA / D C C NO ACTIVITY I.oQfT'S 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 . METHOD (C heck no more than two) (A) m a c r o s c o p ic (M) [ ^ M i c r o s c o p i c (X) X - R A Y (F) F IEL D EXAM (P) PHY EXAM f B j Q B A C T (O) \ ORGAN ( C ) CHEM (TV) W / O A N A L ( L ) [ I BIO GPO 9 34-26 ! ANALYST WORK SHEET 3. S E A L S I 1INTA CT |~ ? BROKEN F I NONE 7. DESCRIPTION OF SAMPLE L 1. P R O D U p T L ^ o /h >&- 4. D A T E RECD 5. R E C E IV E D Ff^OM ' -f *? f c 'VT*' 2. S A M P L E N U M BER 2 o 6. D IS TR IC T OR DIVISION _yr.-. .C .2- 8. N ET CON TENTS Q not a p p l ic a b l e Q NOT DETERMINED 3 UNITS EXAMINED to. SUM M A RY O F A N A L Y S IS Q d e c l a r e d . _____ AMOUNT FOUND. % O F D E C L A R E D , ___ 9. La b e l in g j 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 | | N ONE f A'f /c U i'y / W ./ , " -~/c//,-/ r ` t"* <- T "TV C / o r . c / // ^ ' / ' , K 'c o a . / ?t 21" ,e/-7<5 ? \ ; L 'J / ` c < L '* J f V - O ' `r ^ ';) ' V ." It. R ESERV E SAM PLE 12. D A T E REPO RTED >< J ( *' / / 15. P R O G R A M D A T A 13. A N A L Y S T fe ; N A M E . v -2 /2 . / C OP E RA TION rj JPM S NO. fBO BI-EV l H A / D C C NO /' l/ u i A C T I V I TY NO. OF OTS `13b. N U M B E R 13c. P C T 4. CALCULA TIO NS ,CHECKED a. b y b. D A T E METHOD (C h e ck no more than two) (A) M A C R O SC O PIC (M) r Z ^ I C R O S C O P I C ( X ) X,R AY (F) | | FI E L D EXAM (P) PHY EXAM ( B J Q b AC T (O ) I |p R GAN (C ) CHEM (N) O W / O AN AL ( L ) 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 . G P O 934-261 / T,-;--l~~*?s~'.--).' mji va.- ANALYST WORK SHEET j 3. S E A L S 1__ J IN T A C T P Y b ROKEN 1 1N O N E 7. D E S C R IP T IO N O P S A M P L E v 1. P R Q D U C T )/ ( ( o .!\ 4. D A T E R E C D , * ; r * v . v . f ' 5. R E C E I V E D FR O M . -y /if / 1 /) / c 2. S A M P L E N U M B E R 6. D IS T R IC T O R D IV IS IO N 8. NET CON TENTS Q n OT A P P L I C A B L E Q NOT DETERMINED Q u n it s E x a m in ed to. SUM M A RY O F A N A L Y S IS 1 | DECLARED AMOUNT FOUND. % of d e c l a r e d . La bel 1NG Q ORIGINAL(S) SUBM ITTED | j ______________________^ C O P I E S S U B M I T T E D | | NONE <t y C' * D 0 ^t c:>a c t / v f :v _ *. ;/ ' ' . . ' *`C /o VC 'I /<*> / . ; / y J a' - . )s 1: Vf:f O ( 'J TV `/ / / / / J ( V r ? / / , v - c i - /A ; / / /?/ . `A /. /, < / ( / : i f c/ G' t ` O ' L ^y if1 r, O <4 <A y j/ / &* n ^t cr. - / / / '< ' * c 11. R E S E R V E S A M P L E 12. D A T E REPO RTED . / / y /- / 13a. A N A L Y S T f e ; N A M E ; /! .; . // , / 13b. N U M B E R 13c. P C U . a. BY . j - ' ~~ CALCULA / TIONS C H E C K E D b. D A T E 15, P R O G R A M D A T A jte. , n- JBQ&Jr.EjM OP E R A T I O N h ia /dcc n o . ACTIVITY N O . OF AO T S HOURS MET HO D (Check no more ihan iwoj (A; Q m a c r o s c o p i c ("m ; Q f j t i T c R O S c o P i c (JSQ X.-RAY ( F ) I I FI E L D EXAM CP) I 1 P H Y EXAM (J3) | | B A C T CO) [~ ORGAN 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 . (C) Q CHEM (N) w / O ANAL (L) BIO J GPO 934-261 ANALYST WORK SH EET l'."'S E A L S *""" '*..... T 'in T a c T * (Tj BROKEN r ~ l NON E 7. DESCRIPTION OF SAMPLE 1. P R O D U C T , A r c-O / V 5 "? V 4. D A T E R E C D 5. R E C E IV E D FROM 'a . . . . - 2. S A M P L E N U M B E R L -K 6. D IS TR IC T OR DIVISION // 8. NET I CON* TENTS P lN O T A PPLIC A BLE f |NOT DETERMINED UN! TS E X AM IN ED 10. S U M M A R Y O F A N A L Y S IS | 1D E C L A R E D AMOUNT POUND % OF D EC L A R ED , L a b e l * 1NG I | ORIGtNAl(S) SUBMITTED |] COPIES SUBMITTED | | N ON E <T oJ - / Lj * & A cTbn a- / * O f. rftV- a . / / /) / / .-/ C / //<'7 , /7 . y &> //j C -H t//: 't : / -- r? 1 / 1 * SU- ` j te a /. O L-i 7 / > c* - e / 7 ^ 2/* ?c< ^ A y /--* S ' / tc ; ' / ; 7 V V <.. L --- / , , // J y ^ * < /7 ? c 11. R E S E R V E S A M P L E 12. D A T E REPO RTED 13a. A N A L Y S T ^ ; N A M E fitM , . . 7 15, P R O G R A M D A T A S M IM OPERATION h ia / d c c n o A C Tl VI TY NO. OF LOTS 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. 'N U M B E R 13c. P C 14. CALCULA TIO NS CHECKED METHOD (C h e ck no more than two) (A) M A CRO SCO PIC (M) M I C R O S C O P I C ( X ) X-.RAY ( F ) | | FI E L D EXAM (P ) PHY EXAM C B ; Q b ACT ( O ) I |p RG AN (C) CHEM (N) Q w / O ANAL (L ) BIO 6 P O 934-26 5Vz<y r- ANALYST WORK SH EET 3. S E A L S INTACT rp TBRO K LN P i NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T -U. 4. D ATE RECO xI 5. R EC E IV E D ,FR O M P , , ~; ' y .. ; vy' / /) ? V SVz</ 2. SAM PLE NUMBER 6. D IS TR IC T OR DIVISION ........................................... -- .III--. II 1 ( i ` K. f ___ ___________ B. N ET CON TEN TS NOT A P P L I C A B L E Q not d e t e r m in e d Q u n it s ex a m in ed 10, S U M M A R Y O F A N A L Y S IS I I DECLARED amount fo un d , % O F D E C L A R E D .. / // / a /c c/ y i & [9. !L A B E L 1NG 1 I [ Q RI GIN A L( S) S U B M I T T E D COPIES SUBMITTED I I NONE C'A c?f 7 \ La / r Y A .'/ t'/fc - \ / / .7 r - C / - .. / L C QA v- v x 'w> y -"r '! // ! - * ,/ Jx J :ry c7c / >V- n *7 A / (m o / ti- c ; / / / S //sa fmC~ ) / 6y- 11. R E S E R V E S A M P L E 12. D A T E REPO RTED 13a. A N A L Y S T f e ) N A M E __d o rt\*M 7 f / T X X r o g 'raT DATA m E2&JUM OP ER A TION a / dcc no ' Y ' ' 7 / /j ACTI VITY NO. OF -OTS FD FORM 431 (8/72) P R E V I O U S ED ITIO N IS O B S O L E T E . 13b. N U M B E R 13c. P C 14. CALCULA TIONS CHECKED b. D A T E METHOD (C heck no more than two) ^ (A) Q m a c r o s c o p i c (M) P I Ml c r o s c o p i c (X ) X..RAY (F) I I FI E L D EXAM (P) Q ] PHY EXAM ( B J 0 B A C T (O) I ORGAN (C ) CHEM (TV) Q w / O AN A L (L ) I i BIO G P O 934-261 ANALYST WORK SH EET 3. S E A L S IN TA C T (T H 'b r o k e n Q none 7. DESCRIPTION OF SAMPLE 1. P R O D U C T U'C 4. D A T E R E C O th // & 5. R E C E I V E D FROM /' 2. S A M P L E N U M B E R /'; 'yf ,6. D I S T R I C T O R D I V I S I O N / TV/ -d . 7> f. , . ' V y- 8. NET CON. TEN TS I I not a p p l ic a b l e j I NOT d e t e r m i n e d [~1 U N I T S E X A M I N E D 10. S U M M A R Y O F A N A L Y S IS | | DECLARED amount po und, % O F D E C L A R E D . ___ 19- La bel- in g [ ORI GINAL(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 | | N ONE ' /7 f c X , 7 ' A- O * 1 1 c> / c 'p / ) w/ 1 V / ? 4 !.. A % */ - r 6" // . . : -1 1 2 , . / V / ' '-/ A 0 Lir, / /- T / t , * / / f f- ` A i c" / ., /, </ . // , ` // / >t~r jic /A *; sT?/> Cf A tv 5*. / / . -1 c 11. R E S E R V E S A M P L E 12. D A T E REPO RTED 13a. A N A L Y S T ^ ; N AM E 7 . 77 // 13b. N U M B E R 13c. P C 14. CALCULA TIO NS CHECKED b. D A T E 15? PRO G RAM DATA =R O B L E K > OP ERATION H IA / D C C NO ACTIVITY NO. OF -o*s 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 . METHOD (C h e c k no more th e n two) (A) ^M A C R O SC O PIC (M) fT-iMICROSCOPIC ( X ) X i R A Y (F) I I FI E L D EXAM (P) Q PHY EXAM ( B ) I I B A C T (O) I lORGAN (C) CHEM (N) Q w / O ANAL (L ) I I BIO GPO 934-261 ANALYST WORK SHEET 3, S E A L S i____1IN T A C T [ 3 " b ROKEN 0 1 NONE T. D E S C R IP T IO 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 O . _____ - _ . . s l J .. ^ / h J # v. /, 0 5. R E C E I V E D F R O M V-/ A V //- A y . - / 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 To / A, A, L A- l_ ___________^; v / _______________ 8. NET 1 CON TENTS P ]N O T A PPLIC A BLE {0 ] NOT D E T E R M IN E D 0 UNITS EXAMINED to. SUMMARY o r A N A L Y S IS 1 1D E C L A R E D AMOUNT FOUND HO F D EC LA RED .. ................. , La b e l in g 0 ] ORI GINAL(S) S U B M I T T E D 1] CO PI ES SU BMI T TED 1 1N O N E j '/ * / * ' / "V , / ' c s A v <-*7 < ,> / '<' x? -, o / ?* ( - C : "* y <\ i t ,/ </ i fi ./? : ' f i-< ' / ` " 1 ^70' ' .-y : v / * ' V. V, 1 , / ; 11. R E S E R V E S A M P L E 12. D A T E REPORTEO /f 13k . a n a l y s t ^ ; n a m e . tv '/ / > 15. P R O G R A M "d A f a " s.m .jL O . PR.gB[vEM lX jOP ER ATIO N a / d c c NO. ACT1VI TY NO. OF .O T S FD FORM 431 (8/72) P R E V IO U S EDITION tS O B S O L E T E . TSb. N U M BER 13c. P C 14. CALCULA TIO NS CHECKED b. D A T E METHOD (C h e ck no more then two) (A) Q ] MACROSCOPIC (M) Q23 MICROS COPIC ( X ) X.-RAY (F ) | | F I E L D EXAM (P) PHY EXAM f f i j Q B A C T ( O ) I ORGAN (C) CHEM (N) Q W / O A NAL ( L ) 0 ] BIO GPO 934-26! ANALYST WORK SHEET 1. P R O D U C T 3. S E A L S INTACT H^TBROKEN n NONE 7. DESCRIPTION OF SAMPLE A. D A T E R E C D c5 a m K c 5. R E C E I V E D FfjtOM F it 2. S A M P LE NUMBER 6. D I S T R I C T OR D IV IS IO N y ft / / " / r' r - r - 7~ B. NET CON** TENTS Q not a p p l ic a b l e { I NOT DETERMINED Q u n it s E x a m in ed 10. S U M M A R Y O F A N A L Y S IS I I d ec lared amount fo u n d , % O F D E C L A R E D ____ 9* L a b e l ing ORI 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 I | NONE / - /m . l f :j 77 / P< 7 < Zf?(?h ro A-<t o J. / g r- /- 3 - 7 Y -S& aa /~/ '/ i* O ' (S ty W <- / f <?- CT . <L~* / /V M l 7 7 S - c / 7. - O m #// " / A'Cr S S A 'A / /A f t & S t a t e A cM y j 7 *% <Y* Cl /'A Ceft / N f t fA / f f /- --3 T O 1 /j o .r A c tU ' A ^ - S ' J2 , / / S 'V ' - A/ /J t / . - A S S '/ / / 'f 'O t 'S z 11. R E S E R V E S A M P L E 12. D A T E REPO RTED p j fP i x fy /^ 13. A N A L Y S T fe ) N A M E u ' '/ A '-A I "A13b. N U M B E R r 13c. P C 14. CALCULA TIO NS CHECKED 15. P R O G R A M D A T A J.MS, OP E R A T I O N nr H I A / D C C NO A C T I VI TY NO. OF LOTS FD FORM 431 (6/72) P R E V I O U S ED IT IO N IS O B S O L E T E . METHOD (C heck no more than two) (A) Q MACROSCOPIC (M) |/*| MICROSCOPIC ( X ) X.-RAY ( F ) \ I FI E L D EXAM (P) [H ] PHY EXAM f B j Q B A C T (O) | |p RGAN (C ) CHEM (7V) Q W / O A N AL ( L ) I I BIO GPO 934-261 ptBmmamm ANALYST WORK SHEET t. P R O D U C T 3. S E A L S P^Tb r o k e n f-- I f N T c f r~l HONE 7. D E S C R I P T I O N O F S A M P L E 4. D A T E R E C O ]S. "R E C E IV E D F^OM o J j z j & s j i -- . - f h *<> ^ f / /(W ?* S l z q l i q 2. S A M P LE N UMBER 6. D IS T R IC T OR DIVISION -O A Z L ___ / z . o W ^ o - / NET CON TENTS [ T 3 n OT a p p l i c a b l e n o t DETERMINED UNITS EXAMINED 10. S U M M A R Y O F A N A L Y S I S 1 |DECLARED AMOUNT POUND % OF D EC LARED 9. La bel; iNG L _ __ Q ] O Rl GIN A L I 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 I I NONE / , / i-'1'- L 7? P LS / ; P z"" -O A / La cT'L / :o J. fe- / Y A a / /- 5" ^ z > C/ 7 7 <2- .e O' C? 0 -> <?V '<**a* ^7 / / / z3 C s i / - . / L p r 5 z 7/ / ; V" o n t( / r 7 v v 5 P - r / / 7 1' . ' 7. 7 z / 7 r M , / w 2 / / / e , - - O c .Cv 7 t <z /* / ( c v4,/ 74 W ` / o / P t.- o A & S & A S -A r 77A A /. j ?. / // z" / '/ Z- 1-Z,/ 0 /' /A / 7 / //in f /O 7 J . a:' 1 / $/ /J / K '. z r 7 h Vj - O /a /. cT s p 7 / 7 7 : 7 v ? , 11. R E S E R V E S A M P L E 12. D A T E REPORTED oj ~77 5. p r o g r a m d a t a 13c. A N A L Y S T f e ; N A M E . . 77-; 1/ -q ~ (EM SJifl. J 'a gBLT.M A C T I V I TY NO. OF OTS FD FORM 43 (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 . 713b. N U M B E f T T i c T P C 1*> CALCULA TIONS CHECKED b. D A T E METHOD (C h e c k no more than two) (A) M A C R O S C O P I C (M) [T^Tm I CROSCOPI C (X ) |-- 1X.-RAY (F) | | FI E L D EXAM (P) [^3 PHY EXAM (B) I |B A C T (O) I ORGAN ( C) CHEM (N) I IW/O A NAL ( L ) Q 5 ,0 g ? r ^ . 7ff--wTnrvr.- .r.~-rsaeor; GPO 934-261 f" : ANALYST WORK SHEET 3. S E A L S [_ j INTACT Q " `b 'r O K E N NONE 7. D E S C R IP T IO N O P S A M P L E 1. P R O D U C T 4. D A T E R E C D '' ? 7 5. R E C E I V E D F R O M ............................_____ __ / t t / i ________________ A ?f 2. S A M P L E N U M B E R 6. D IS T R IC T O R D IV IS IO N ! 6. NET CON- ' TENTS NOT A P P L I C A B L E I |NOT DETERMINED UNITS EXAMINED 10. S U M M A R Y O P A N A L Y S IS Q J DECLARED _ AMOUNT FOUND V. O F D E C L A R E D _ 9. La b el in g 1 I ORIGINAL(S) SUBMITTED I1 CO PI E S SU BMI T T E D 1 1N O N E / 7^4 cS e / / C* /j ' > v (ft J-C- 3 . P^-p /? ir. <**<// t '' / "v-`<L . --/ 0/ / / c r' 1 /* / * ce / /' <OT r~St -4 < o - r / y y ~ d ;7 .4 - // : t>. ^/* 4 // <y /' <*/'' /. /? " . *[?-, ( 7 / sj 7- 11. R E S E R V E S A M P L E 12. D A T E REPO RTED "7 713a. AN A L Y S T ( ) N A M E liCZ I 15. P R O G R A M D A T A ' m im* EILS lr,FM OP E RA TI ON A /D CC NO. A C T I V I TV NO. OF LOTS 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. N U M B E R 13c. P C 14. CALCULA TIO NS CHECKED b. D A T E METHOD (C h e c k no more then two) (A) Q MACROSCOPIC (M) jT~ 'M l CROSCOP1 C (X ) X . . R A Y (F) | | FIE L D EXAM (P ) I 1 PHY EXAM (B) I I b ACT (O) \ lO R G AN (C) CHEM (N) W /O ANAL (L ) Q BIO GPO 934-261 I. PRODUCT "J T T a m p T e TTu m b e r 1 ANALYST WORK SHEET M Cf i i A ) a *> ' A /? ' Y 3. S E A L S IN TA C T 4, D A T E R E C D I T " R E C E I V E cf/ ROM |,6. D IS T R IC T OR DIVISION BROKEN NONE 7. DESCRIPTION OF SAMPLE S L A A p ^ A f. c )G. ) N O T A P P L I C A B L E N E T | | | N QT D E T E R M I N E D CONT E N T S j ) U N IT S EXA M IN ED 10. S U M M A R Y O F A N A L Y S IS | j DECLARED AMOUNT FOUND, % OF D E C L A R E D 3. LA BEL IN G 0 ORIGINAL(S) SUBMITTED | | ________ ________ COPIES SUBMITTED 1 | NONE A 7a/c- P - . C 7 & A .X A " " A X ). O t -tr 4' ? (rSf-'j'l <5$.. / / ^ s . / r < A C ~~~ A A f / i - c c } 0 T ( A x . i r Cfi C A n y S o yv lx ~ s . u - & A S -y * - ^ v j y /t / /??of)`7"-'c. J? & c:'& '7 A A / fix *)'/*^*a *A Jf'c^A'Cf/'<A C*^a a O . CJ A? 7> C 7 t/ ' / j \ 'x T S .y a i A * c ' C A A/ f/ y / cr1?- & A cC ^ -S0 (A 11. R E S E R V E S A M P L E 12. D A T E REPO RTEO "p O y i/ ff 13a. A N A L Y S T ^ ; N A M E y / , 1W - .A 15, P R O G R A M D A T A OPERATION mm PP4J.-E-M a /dcc no // ^S.b, N U M B E R O ft/s- t- , 13c. P C 14. CALCULA TIO NS CHECKED a. BY b. D A T E A C T IV I TY NO. OF LOTS HOURS METHOD (C h eck no more than two) (A) M A C R O S C O P IC (M) (T^RTl CR OSCOPIC ( X ) X.-RAY ( F ) | | FI E L D EXAM (P) ) PHY EXAM (B ) I I B A C T (O) I lORGAN (C) CHEM (N) Q w / O ANAL (L ) 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 . 6 P 0 9 3 4-261 ; ANALYST WORK SHEET 3. S E A L S 1 1I N T A C T BROKEN I 1N 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 / /VO 4. D A T E R E C D /, S. R E C E I V E D F R O M ,,/L 2. S A M P L E N U M B E R ^ .... 4 /. 6. D I S T R I C T OR D IV IS I O N 8. NET CON TENTS 1 I NOT A P P L I C A B L E N O T DETERMINED UNI TS EXAMI N ED 10. S U M M A R Y O F A N A L Y S I S DECLARED/UNIT. AMOUNT FOUND % OF DECLARED 9. LABEL ING I 1O Rl GIN A U 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 2. D A T E REPORTED ( /1 5. P R O G R A M D A T A P M S NO. PR OB FD FORM 431 (5/73) 13a. A N A L Y S T ^ ; N A M E O PE R A T IO N A/DCCNO AC TI VI TY NO. OF P R E V I O U S E D IT 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 ION ! CHECK b. D A T E METHOD ( C h e c k no m ore th e n 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) x . - R A Y (F) I I FI E L D E X A M (P) PHY E X A M (B) 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 O F PAGES. prs; ANALYST WORK SHEET 3. S E A L S I 1I N T A C T [ BROKEN 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 'i 5. R E C E IV E D FROM 2. S A M P L E N U M B E R k~~ / 6. D IS TR IC T OR DIVISION 8. NET CON TENTS NOT A P P L I C A B L E N O T DETERMINED UNI TS E X AMIN ED 10. S U M M A R Y O F A N A L Y S IS DECL A RED/UNIT, AMOUNT FOUND % OF DECLARED 9. LABEL ING ORIGINAUS) SUBMITTED | | __________________________ C O P I E S S U B M I T T E D | | NONE 1/ 1. R E S E R V E S A M P L E 2. D A T E J: ' R EPO R T ED 7 13a. A N A L Y S T ( b) N A M E 5. P R O G R A M D A T A O P ER A T IO N ZM S. 3 R O B I .E Iv H IA / D C C NO. A C TI VI 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. PCj'14. METHOD/ CACULA- TION CHECK b. DATE METHOD (C heck 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) 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 ACT /O; O R G A N (C) C H E M (N) 0 x 7 / 0 A N A L (L) B IO PAGE O F PAGES. A N A LY ST WORK S H E E T 3. S E A L S 1____( I N T A C T {X3 B R O K E N j j 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 / L 4 x 4. D A T E R E C O . ^,, V* . - 5. R E C E I V E D F R O M -( j / - .. , 2. S A M P L E N U M B E R 6. D I S T R I C T OR D IV IS IO N -, - V 7 8. NET CON! TENTS P ]N O T A PPLIC A BLE ! 1NOT D E T E R M I N E D j" *) U N I T S E X A M I N E D tc. SUMMARY OF A N ALYSIS | | DECLARED,,, AMOUNT POUND % OF D EC LARED X, C ( <j c r o ' - C . , La bel in g | 1O RI G IN A L ( S ) S U B M I T T E D |( COPIES SUBMITTED 1 |NONE '< o r / L`/ /, C X ' i It. R ESERV E SAM PLE 12. D A T E REPO RTED 13a. A N A L Y S T ^ ; N A M E ' /. / 13b. N U M B E R 13c. P C 14. CALCULA I J TIONS CHECKED b. D A T E 15. P R O G R A M D A T A ' ELMS. PR O BLEM ttfJFv-i-- . -- 1 I in O P E R A T IO N H I A / P C C NO A CTI VI TY NO. OF ,O T 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 . METHOD (C h e ck no more than two) (A) Q MACROSCOPIC (M) fS^MI CROSCOPI C (X) O X . - R A Y (F) | | FI E L D E X A M (P ) [3 ] P H Y E X A M f B j Q B A C T (O) f |p R G AN (C) Q 3 C H E M (N) n w / A N A L ( L) B I O G P O 934-261 : ANALYST WORK SHEET ; 3, S E A L S in t a c t IT "] B R O K E N CD NONE 7. D ES C R IPT IO N O F S A M P L E t. PRO D UCT C. < < 4. D A T E R E C D * v'~- '<* ` ' * < 5. R E C E I V E D F R O M .. . ^ ... /' 2, S A M P L E N U M B E R 6. D IS T R IC T OR D IV ISIO N - 8. NET CON TEN TS Q n OT APPLICABLE not determ ined Q UNITS EXAMINED 10. S U M M A R Y O F A N A L Y S IS I I DECLARED amount fo und. T. O F D E C L A R E D La bel in g | | ORIGINAL(S) SUBM ITTED | | ___________________ C O P I E S S U B M I T T E D | | NONE C -Z (\ `7 7 ) ' (\ ' - e ~y -- /.. / -1 " , /t - " t l c . .\ / * - <" ' < . - i t /, J L' y /7 c i ' p / r ;> 11. R E S E R V E S A M P L E 12. D A T E REPO RTEO 15. P R O G R A M D A T A M S,JiSU FD FORM 431 (8/72) 13e. ANALY STfe) NAME . / /' / 13b. DUMBER cf 13c. P C f14. CALCULA TIO NS CHECKED 8. BY b. DATE O P ERA TION H A / P C C NO. A C T IV IT Y NO. OF -OTS P R E V I O U S ED ITIO N IS O B S O L E T E . (A ) M A C R O S C O P IC (M) r R ^ i c R O B C O P ! c e x ; X j-RAY (F) | | FI E L D E X A M (P ) P H Y E X A M (B ) I | B A C T (O ) I | p R G A N (C) CHEM (N) Q W / O A N A L (L) | | BIO G P O 934-261 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 BROKEN )1____ I N T A C T 1 1N O N E 7. D E S C R I P T I O N O F S A M P L E '. PRODUCT / - 4. D A T E R E C D . - ... 5. R E C E I V E D F R O M ' *' 2. S A M P L E N U M B E R 'i 6. D IS T R IC T OR D IV ISIO N 8. NET CON TENTS not a p p l ic a b l e [ ] not d e t e r m in 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 DECLARED/UNIT. AMOUNT FOUND % OF D E C L A R E D . 9. LABEL ING 3 ORI GIN AL ( 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 I; / r * . CL. /, (r: ( 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13. A N A L Y S T (a) N A M E 15. P R O G R A M D A T A PR O BLEM o p e r a t io n ] B IA / D C C NO A C T I V I TY NO. UOT5 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. PCJ14. METHOD/ CACULA- T I ON CHECK b. DATE METHOD (C heck no more than two) (A) MACROSCOPIC (M) T M I CROSC O PI C ( X ) ] XrRAV (F ) | | FI E L D EXAM (P) PHY EXAM ( L B J Q b A C T ( O ) I |p R GAN (C) CHEM (N) ]W / 0 ANAL ( L ) BIO PAGE PAGES. : ANALYST WORK SHEET 3. S E A L S f ~ ] IN TAC T BROKEN Q NONE 7. DESCRIPTION OF S A M P L E 1. P R O D U C T : .. , 4. D A T E R E C O 5. R E C E I V E D F R O M 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 |e. NET CON TENTS Q hot a p p l ic a b l e n o t d e t e r m in e d u n i t s EXAMINED to . SUMMARY OF ANALYSIS I 1D E C L A R E D , AMOUNT f o u n d , O F D E C L A R E D ____ S. La b e l in g ] ORIGINAL(S) s u b m i t t e d I I _______________ CO PI ES S U B M I T T E D I | NONE / / (. ! / J u c 11. R E S E R V E S A M P L E 12. D A T E REPORTED / ` ... i ' 'if / 13e. A N A L Y S T ^ ; N A M E . ,. 15, P R O G R A M D A T A ___ PROBLEM OP ER A TIO N H IA / P C C NO. . ./ A C TI VI TY NO. OF koys 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 . 13b. N U M B E R 13c. P C 14. CALCULA TIONS CHECKED b. D A T E METHOD ( C h e c k no more t ha n tw o ) (A) M A C R O S C O P IC (M) n ~ i MI CROSCOPIC ( X ) X.-RAY (F) F I E L D EXAM (P) PHY EXAM W Q b A C T ( O ) I lORGAN ( C ) CHEM (TV) w / O A N A L ( L ) BIO G PO 934-26! 1. P R O D U C T ANALYST WORK SHEET , f 3. S E A L S ; 03 BROKEN in t a c t P~1 N O N E 7. D E S C R I P T I O N O F S A M P L E 4. D A T E R E C D ,. t 2. S A M P L E N U M B E R ' ***' 1 ' , i r ^ 5. R E C E I V E D FROM, 6. D I S T R I C T OR D I V I S I O N [e. NET CON* \ TENTS IT- i -* 1 11 - [ N O T A PPLIC ABLE | |n o t d e t er m in e d un its examined 10. S U M M A R Y O F A N A L Y S I S ( 1DECLARED amount found % OF D EC LA RED _ - s. La b e l in g ( ORI GINAL(S) S U B M I T T E D I I __________________________ C O P I E S SUBMI T T E D I I NONE / ' (( II( '/ 'r. U 11. R E S E R V E S A M P L E 12. D A T E REPORTED / 13*. AN A L Y S T f e ) NAM E / 13b. 'Nu m b e r 13c. P C 14 CALCULA TIONS CHECKED b. D A T E 15, P R O G R A M D A T A .EMS, .p r o b l e m OP ERA TION H A/DCCNO ACTIVITY NO. OF .W 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 . METHOD (C heck no more then two) (A) M A C R O S C O P IC (M) m ^ f C R O S C O P I C ( X ) Xj RAY ( F ) | j FI E L D EXAM (P) PHY EXAM ( B ) [ B A C T ( O ) I ORGAN (C) CHEM (N) w / O ANAL. (L ) BIO G PO 934-261 : ANALYST WORK SHEET '3. S E A L S r i IN TAC T [ [ 'BROKEN I 1N 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 j 4. D A T E R E C D 7 -- : ('<-, . , 5. R E C E I V E D F ROM' 2. S A M P L E N U M B E R /-Z'* '"'O w 6. D IS T R IC T OR DIVISION M- 8. NET CON TENTS I I NOT A P P L I C A B L E NOT D E T E R M I N E D UNI TS EX AMI N ED 10. S U M M A R Y O F A N A L Y S I S DECL A RED/UN1T . AMOUNT FOUND O F DECLARED. / / Z) , c/ ? V* a / ^/ X' ;; & V ./ / 77- :<- 9. LABEL ING ORIGINALlS) SUBMITTED j | ___________________ _ C O P I E S S U B M I T T E D | | NONE .'T ? 1 1. R E S E R V E S A M P L E u12. D A T E REPORTED / Y,< , 7 V 13 e. 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 M ? , UP . , ____ P R O B L E M OP E R A TIO N l H 1A /D C C NO. 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 . 1/3b. N U M B E R 13c. P C 14. METHOD/ CACULA- TION ! CHECK b. DATE METHOD (C heck no more then two) (A) m a c r o s c o p i c (M) [ m i c r o s CO P I C (X) Q X.-RAY (F) | | FI E L D EX A M (P) Q ] PH Y E X A M (B) | |B A C T (O) I [ORGAN (C) CHEM (N ) w/O A N A L (L) BIO page of pag es. ANALYST WORK SHEET 13. S E A L S 7 3 IN TACT P I BROKEN ( 1NONE 7. D E S C R I P T I O N O F S A M P L E . PR O D U C T 1 l--'t 4. D A T E R E C O ->> _ 5. R E C E I V E D F R O M 2. S A M P L E N U M B E R / - / y O s3 6. D I S T R I C T OR D IV ISIO N 8. NET CON TENTS NOT A P P L I C A B L E NOT DET 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/U N I T _ 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 / 7>/c. -7: - '/. o V v- /// a -, 7 c / 4 , , /*. 77-i// 7 7 V. 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 ^ ; N A M E /,,< V 7 7 ' 15. P R O G R A M D A T A P M S NO. PR O B LEM o p e r a t io n H IA /D C C NO. A C T I V I TY NO. OF UOTS J3b. N U M BER 13c. P C 14. METHOD/ CACULA- T l ON ! CHECK b. DATE METHOD (C h e ck no more than two) ( A ) [73 M A C R O S C O P I C (M) P T m I CR OSCOPI C (X ) X..RAY (F) | | F I E L D EXAM ( P ) |73 P H Y E X A M (B ) B A C T (O) I |o RG AN (C) |73 CHEM (N) 73W/ 0 A N AL ( L ) 7 3 B , 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 . ANALYST WORK SHEET 3. S E A L S INTACT 3 BROKEN 1 1N 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 ; T. 4. D A T E R E C D ,/ v < . / V ;; i S. R E C E I V E D FR O M v-v S J'C 2. S A M P L E N U M B E R 6. D I S T R I C T OR D IV IS IO N NOT A P P L I C A B L E NOT DE T ER M IN ED 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 DECL A RED/UNI T AMOUNT FOUND % OF DECLARED / r. (' / 9. la bel in g 1 O Rl GIN A Lts) 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 . i, <.7 ,5 / / /": 1V ! ? x" / \ //< ''> / 11. R E S E R V E S A M P L E 12. D A T E REPORTED 13 e . A N A L Y S T ( a ) N A M E '/ T .. t 15. P R O G R A M D A T A PROB LE M OPERATI I1 H 1A /D C C NO. 13b. N U M B E R 13c. P C 14. METHOD/ CACULA- TI ON b, D A T E i CHECK A C TI VI TY NoOr. OTS HOURS METHOD (C h eck no more than 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 ) X. - RAY (F ) | | FI E L D E X A M (P) P H Y E X AM (B) 1 | B A C T (O) I O R G AN (C) C H E M (N) Q w / O A N A L (L) BIO J 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 . ANALYST WORK SHEET 3. S E A L S I I INTACT [ S BROKEN I INONE 7. D E S C R I P T I O N O F S A M P L E t. P R O D U C T 4. D A T E R E C O 5. R E C E I V E D F R O M 2. S A M P L E N U M B E R ' /S 'C 6. D I S T R I C T OR D IV IS IO N - f/ NET CON TENTS ( NOT A P P L I C A B L E Q n OT D E T E R M I N E D UNI TS E X A M I N E D 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/UN1T. AMOUNT FOUND % OF DECLARED. /. / # ' C a* '/ /c 9. LABEL ING ORIGINAL(S) SUBM ITTED I 1________________________ C O P I E S SU BMI T T E D I I N ON E o .? c w /, - ( I (/ O' 0/I / 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 (e) N A M E >/ 15. P R O G R A M D A T A ms, PR O BLEM OP E RA TION H I A / D C C NO / A C TI VI 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. N U M B E R 13c. P C 14. METHOD/ CACULA- TI ON i CHECK b. D A T E METHOD (C h eck no more than 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) Q x -RAY (F) | | FI E L D E X A M (P) PH Y EX A M f B j Q B A C T ( O) I ORGAN (C) C H E M (TV) Q w / O A N A L ( L ) BI O PAGE O F PAGES. A N A L Y S T WORK S H E E T 3. S E A L S f IINTACT BROKEN | | NONE 7. DESCRIPTION OF SAMPLE 1. P R O D U C T / L J / 4. O A T E R E C D . 5. R E C E I V E F R O M /g. / A 1. / ///, V-- ' V 6. D I S T R I C T OR DIVISION 8. NET CON TENTS n o t APPLIC A BLE NOT DET ER M INE D UNI TS EXAMIN ED 10. S U M M A R Y O F A N A L Y S I S DECLARED/UNI T AMOUNT FOUND % OF DECLA RED 9. LABEL ING .. 0 ORIGINAL(S) SU BM ITT ED | | ________________________ C O P I E S S U B M I T T E D | |NONE / T &7 S '" * ' ^ 2_ A ,/ 7. * C # r & ' a- / < ^ S * / i* - 5^ j- / / / /f M A ' - C 7/ P sJ'>H -. y/ r / ' A * - / 1 '6 ^ * C t* ' i 'i l o - t v5 ( ... I i ( - : / 0 /i * , V /, /' 7. TteJM. c f / -t 9<r< 7 - v - 4 i ^ y / h f 11. R E S E R V E S A M P L E 15. P R O G R A M D A T A EMfi H0a 1. FD FORM 431 (5/73) H IA /D C C NO. A C T I V I TY NO. O T S ______H O U R S P R E V I O U S E D IT I O N IS O B S O L E T E . 13c. P C | U . METHOD/ CACULA- TI ON | CHECK b. D A T E METHOD (C heck no more than two) (A) M A C R O S C O P IC (M) |~0~m i c r o s c o p i c ( X ) x . - R A Y (F) | | FI E L D EXAM (P) PHY EXAM / B / O b A C T (O) | ORGAN (C) CHEM (TV) W / O ANAL ( L ) I I BIO YTi-yr-ir - c -;:; zxaxzzca' 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. 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 N A L Y S T WORK S H E E T 3. S E A L S r~l INTACT BROKEN I 1N 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 2. S A M P L E N U M B E R _______ ,, X i Z i Ili- _ 1 _____ . _____ A 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 I S T R I C T O R D I V I S I O N / ' q / C r . 's f . /'/S i JEJ >... Vfr.' .ir- /V 8. NET CON TENTS Q NOT A P P L I C A B L E ] NOT D ET ER M IN ED ____U N I T S E X A M I N E D 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 t T _ AMOUNT FOUND 7. O F D E C L A R E D . 9. LABEL ING | | ORI GINA L(S) 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 | |NONE Cl (V c C-<7tSonfC/cc, *? / . - -, Vc-*f c / //) / 7 /-} - //- r l -j / / / - / -- - Ij ' - C., '/ / ' -V 7 ' 6Vv, I. S 'r ` X / ,c r..-. c /"7 / / - c ./ / O V/ // y/ 7 ' ^ i y* f " / /"? - C r f - / ^9 . 6? / Y\ i y (/ L. - ' ^ ( 7 - 7 I s ? ' / c - ( f~ .$ T X/ //:*< : / { s ' < i l / <? ' V.C) 11. R E S E R V E S A M P L E .. 12. D A T E REPORTED ;<CX/ 15. P R O G R A M D A T A 13 e. A N A Q Y S T f ; N A M E V / / / ./ / O P ER A T IO N y MS NO. PROBLEM H A /D C C NO. // X/ - X /1 13b. N U M B E R 13c. P C 14. METHOD/ CACULA- TI ON i CHECK b. D A T E A C TI VI TY OTS HOURS METHOD (C heck no more than two) (A) M A C R O S C O P IC (M) P=huTi C ROSCOPI C (X) Q X.-RAY ( F ) | | FI E L D EXAM (P) PHY EXAM (B ) Q b ACT (O) I |p R GAN rl (C) CHEM (N) w / O A NAL ( 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 PAGES. ! ANALYST WORK SHEET 13. S E A L S [[ INTACT 3 3 BROKEN I 1n 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 C i D U C T ^\ 4. D A T E R E C D -.V. / 5. R E C E I V E D F R O M A'f / A 11. 0 `- c '3 2. S A M P L E N U M B E R 6. D I S T R I C T OR D IV ISIO N 8. NET CON TENTS | | NOT A P P L I C A B L E Q 3 NOT DE T ER M IN ED UN I 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 L A R E D/U N I T _ AMOUNT FOUND % OF DECLARED 9. LABEL ING 33! ORI 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 | "1 N O N E dt?/ on / C) J- y / ' /<- K"' . w . . -( ! ( > ^ {j j -- cP-' / c O /n // u* 7 Vc /d /c -c , n s -A / // / / - / / Jpy/i / c Q> / >OC < or 2 </1)/9... 7At??7/'i - c - n c c n s * // / f f # - ; V / / 'a f / r< < 5 - -d 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 Q Y S T / s ) N A M E V/ / 15. P R O G R A M D A T A PM S NO. PR O B LEM OP ER A TIO N H IA /D C C NO 13b. N U M B E R 13c. P C 14. METHOD/ CACULA- Tl ON CHECK b. D A T E A C T I V I TY NO . OF ,O T S HOURS METHOD (C heck no more then two) (A) 3 3 M A C R O S C O PI C (M) CROSCOPIC (X) [33 X.-RAY (F) | | FI E L D E X A M 33(P) P H Y E X A M C B / [ 3 3 B A C T C> I ORGA N (C) 33 CHEM (N) 33w/ A N A L (L ) 3D 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. i A N A LYST WORK S H EE T 3. S E A L S INTACT fp-^ROKEN I 1N O 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 A--u". 4. D A T E R E C D A - .... ) f 4.,,. j. ' ' c -y-- / 5. R E C E I V E D F R O M 2. S A M P L E N U M B E R cj 6. D I S T R I C T O R D IV IS I O N Ct -V f j - , , , y 8. NET CON TENTS P J no t a p p l ic a b l e Q NO T D E T E R M IN E D U N IT S E X A M IN E D 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 I T_ AMOUNT FOUND % OF D EC LARED 9. LABEL ING Q O R IG IN A L (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 / O' ' fl/ / (j? , <~7 /, 7 7 ./ c , /3 / 07 - > 7j --*vsQas y tX- C ' /- r CP ' -y , (-;/ / / / /.-/A c .L_i- - -~?y .. / y i. ; ; / Cs'- /i f // ' Li 9. s o5-- - L / \ / < - / O / /l ( CS 7 'r -t/n c - e /' / t f / ? -4* ' ~ V <' / / s ' f S t ... , ^ ' -/ / ~ o S& 11. R E S E R V E S A M P L E 12. D A T E REPORTED OV C? (. ,' u \ 'Jj' 13a. A N A L Y S T f s ; N AM E -/ iiL ,V 15. P R O G R A M D A T A O P E R A T IO N H IA / D C C NO s ' / v- 13b. N U M B E R 13c. P C 14. METHOD/ CACULA- TI ON CHECK b. D A T E A C T IV I TY NO. OTS HOURS M E T H O D (C h eck no more then two) (A) M A C R O S C O P I C (M) i ~ A ^ M f - C R O S C O P I C (X) P X ^ R A Y (F) | | F I E L D E X A M (P) [ P P H Y E X A M (B) I I B A C T (O) I O R G A N (C) ( P j C H E M (N) O 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. j ANALYST WORK SHEET 3. S E A L S 1 INTACT F~l BROKEN n NONE 7. D E S C R I P T I O N O F S A M P L E PRODUCT L, D A T E R EC D <Z*CaJ / P i d ''i 5. R E C E I V E D F R O M / 3d- /& 3 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 11 i f 'T s 8. NET CON TENTS n o t a p p l ic a b l e n o t determ ined [ U N IT S EX A M IN ED A N A L Y S IS [ | D EC LARED AM OUNT FOUND. % OF D EC LARED 9. I L a b e l -! 1NO I ] ORIGINA L(S) SUBM ITTED j-- ^ CO PIES SUBMITTED [ I NONE / /a c sO - __. cc 73 .r / * Caren S O - /O 3 (f / Sr i3 y ; /t // C. / 0 / 3 ' / / - . // ^ /- ^ r; . r / A 4T. C j C : '/ t 'i ' . > C / ? / y j 5 a ~ f~ / l c h ? / j? / r o / r< ~ ?Z '1 / C - A t .C '( r r l r v/ / * ^ e/' f? tf JJ j - < i r/-/ 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/ --- :----- *__________ L L - /s . / 13b. N U M B E R 13c. P C 14. CALCULA . TIONS CHECKED 15, P R O G R A M D A T A EMS. Ufi. E3P-LA.M OP E R A T IO N A /D C C NO. A C Tl VI T Y NO. OF LOTS 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 . METHOD (C heck no more than 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) X . - R A Y (F ) | | F I E L D E X A M (P) P H Y E X A M ( B ) Q b A C T (O ) I O R G A N (C) C H E M (TV) W / O A N A L ( L ) B I O GPO 934-261 r --- " 1 ............1' A N A L Y S T W ORK SHEET 3. S E A L S Q BROKEN L_) INTACT O 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 O 5. R E C E I V E D F R O M 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 ...... . NET CON TENTS H NOT A P P L ! C A BLE | 1N O T D E T E R M I N E D , UNITS EXAMINED ; 10. S U M M A R Y O F A N A L Y S I S ( | DECLARED AMOUNT FOUND % OF D EC LARED , S. LABEL ING Q 3 O Rl GIN A U S ) S U B M I T T E D I) COPIES SUBMITTED I I NONE 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 ^ ; N A M E 13b. N U M B E R 13c. P C 14. CALCULA TIONS CHECKED b. D A T E 15, P R O G R A M D A T A L M& . tiSU. PR Q U M O P E R A T IO N A / D C C NO. A C T IV IT Y 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 than two) (A) M A C R O S C O P I C (M) Q M IC R O SC O PIC (X) X..RAY (F) | l FI E L D EXAM (P) PH Y EXAM (B) B A C T (O) I ORGAN (C ) C H E M (TV) Q w / O A N A L (L ) B IO GPO 934-26* ANALYST WORK SH EET T s E A L S ' " ` r~ ) INTAC T broken NONE 7. D ESC RIPT IO N OP SA M PLE 1. P R O D U C T 4, D A T E R E C O 5. R E C E I V E D F R O M 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. j NOT A P P L iC A B U E NET I ^ I { NOT D ET ERM INED T E N T S ( UNITS EXAMINED 10. S U M M A R Y O F A N A L Y S I S DECLARED AMOUNT FOU1% OF D EC LA RED . 9. La b el in g Q ORIGINAL(S) SUBMITTED | 1________________________ _ C O P I E S S U B M I T T E D | |NONE I-- - 11. R E S E R V E S A M P L E 12. D A T E REPO RTED 13a. A N A L Y S T ^ ; N A M E 13b. N U M B E R 13c. P C 114. CALCULA TIONS CHECKED 15, P R O G R A M D A T A EMS, KP.a. J R.PfiL.EM OPERATION H A / P C C NO. ACTIVITY NO. LOTS I OURS 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 heck 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 ) X . - R A Y (F ) | 1 FI E L D E X A M (P) P H Y E X A M fB )Q B A C T (O ) I O R G A N (C) C H E M (N) w / O A N A L (L) B I O GPO 934-261 ; ANALYST WORK S H E E T 3. S E A L S r 1INTACT 1 [ 3 BROKEN [ 1N 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 / . D A T E R E C D t y /-> , ' . / v< L / '% 5. R E C E I V E D F R O W r i 2. S A M P L E N U M B E R / "- / O 6. D I S T R I C T OR D IV IS I O N jt . 8. NET CON TENTS f | NOT A P P L I C A B L E | NOT D E T E R M I N E D UNI TS EX AMI N ED 10. S U M M A R Y O F A N A L Y S I S DECL A RED/UN I T AMOUNT FOUND % OF DECLARED 9. LABEL ING Q O R IG IN A U S l S U B M IT T E D | | _____________________________ C O P I E S S U B M I T T E D [ | NONE A ?V /.r -- : ^ %*? ., .y O/ )' ' / V / ./ ^ / y^ /Af S f . U 1'b- ~ A f ///// / S'- C^ s i/ //t f r ' / / < - k - f1x.-t. -'// {/ O ^1 / / / 1 //.1/ ?">* j 7/{'//' S/ / ^ Si / 11. R E S E R V E S A M P L E 12. D A T E ! REPORTED - / -/ '7 j A (-j J'V s - A 1 ! 13a. A N'A L Y S T fa,) N A M E 7 . t f , J 1 ,1 / 15. P R O G R A M D A T A ,P M 5_ N O , PR O BLEM OP E R A TION HIA/D CC NO. // l b . N U M B E R 13 c . PC. U . a. B Y a- :** 1 METHOD/ CACULA- / TION b. D A T E 1 CHECK A C T IV I TY NO. (A) M A C R O SC O PIC (M) 'M i CROSCOP1 C (X) X .- R A Y (F) F IE L D EXAM (P) PHY EXAM ( B j ^ B A C T ( O ) I |ORGAN (C) CHEM (N) Q W / O ANAL ( L ) I I 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 . AN ALYST WORK SH EET 3. S E A L S IN T A C T ( B R O K E N 1 1N 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 A. 4. D A T E R E C D 1 5. R E C E I V E D F R O M (/ /-- V J/ J A w/ 2. S A M P L E N U M B E R V**"" 6. D I S T R I C T OR D IV IS IO N ./. ' 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 UNI TS EX A M IN ED 10. S U M M A R Y O F A N A L Y S I S D E C LA R E D / U N IT . AMOUNT FOUND % OF D EC LARED . 9. LABEL ING 3 O RI G IN A U 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 t/ /. 7* c ? %s . J. (C'Vc/V;(it Jf. A U 1? l/ ./// '// / : ?/'/V7'C- - V I V / /7/ a / /<y/ 7/ / i'/i'/cT.o//A - v J y / M/z /'t4. -- ,/ c s e / * t *'/ r /( 11. R E S E R V E S A M P L E 12. D A T E REPORTED 7 ( 13a. A N ^ L Y S T jf s ; N A M E J 15. P R O G R A M D A T A / M S NO. 1. PR O B LE M O P E RA TIO N H IA /D C C n o . -s-// il A C T I VI 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 . 1Tib. N U M B E R 13c. P C 14. METHOD/ CACULA- TION ! CHECK b. D A T E M E T H O D (C heck no more than 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) ( X - R A Y C F ) I I F I E L D E X A M (P) P H Y E X A M ( B) B A C T (O) I ( O R G A N (C) C H E M (N) J w / O A N A L (L) B I O PAGE O F PAGES. ANALYST WORK SH EET 3. S E A L S I I IN T A C T HTTb ROKEN ( I NON 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 1/ <csJ/> w <w/ 4. D A T E R ECD 5. R E C E IV E R PROM 7 C~(-t 4 2. S A M P L E N UMBER 6. D IS T R IC T OR DIVISION 8. NET CONTENTS | |NOT A PPLI C A B LE | N O T D E T E R M IN E D U N IT S E X A M IN E D 10. S U M M A R Y O P A N A L Y S I S D E C L A R E D / U N 1T AMOUNT FOUND % OF D ECLARED / 1 o/c> n QK.J rsh -# -- P 9. la bel- ING O Rl G IN 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 OS / 0/ c / ,/ /,4 ? U - <` / J J n fc ff f' v I/c'}v-A1r v* yf _ // / ^ C s f y / 'W f ; < t -- v /> < / * C /'h L ^ > ^ 5 J / U -( // " A -/ i ( < P / t' Ci! 'J / t ,.C >?. t" // ,fy . / '7 / n it - a `P i x i -p t i 'l & jU ' 7 .j* / y5 \ // A , , : , . / V W ^' L. Or J 11. R E S E R V E S A M P L E / A A / if ' ^ vt l is t-i <O v 12. D A T E RFPO RTF D 13a ./, -ANNAALLYY S T (s.) N A M E 13b. N U M B E R 13c. P C 14. / .../-I METHOD/ 1 CACULA- TION b. DATE I CHECK 15. P R O G R A M D A T A PM S NO. PHOBLEK/ O P E RA TIO N H IA /D C C NO. A C T IV I TY NO. O T S HOURS METHOD (C heck no more than two) (A) Q M A C R O S C O P I C (M) [ ~ ~ h h v f i ~ C R O S C O P I C (X) X i R A Y (F) F I E L D E X A M (P) P H Y E X A M ( B J Q b A C T (O) O R G A N (C) C H E M (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 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 OF 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. ^3~33._----i ANALYST WORK S HE ET 3. SEA LS fH IN T A C T [I^ B R O K EN ) 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 RECD 5. R E C E IV E D FROM A jS 2. S A M P L E N UM BER 6. D IS T R IC T OR DIVISION 8. ! NET l' CON1 TENTS | 1N O T A P P L I C A B L E NO T D E T E R M IN E D U N IT S E X A M IN E D D E C L A R E D/U N I T AMOUNT FOUND % OF D EC LARED 9. LABEL ING ( O Rl G IN A U S ) S U B M I T T E D |1 C O P IE S SU B M IT T ED | | NONE 10. S U M M A R Y O F A N A L Y S I S / /y -azi Ke . A) (.S ? / 4 a /JfbfOeil f*" A Cc y C 6 / o - '1 / 3 3 O a / y - A -a J/fof-'*/<;.... / ( 0 * Ca S t '/ & o V 7 , 7 /7 f*ivelr? * &A. / / /' / <07 -~0 7 1 ' (t ^ (MJJrxsc 1 ' J J ).,J,, /,, /? t'l \ f I ( C i.-'/ ^ ~4 / >`ACS f'Ki A,,?/V9. -'fif // '* !L *) ) ^ * 7 * ^ " *' C i *' 'A ,, 'a "- ra-<k`'/ 7. , / '1 '/ '4* 7 -- / A * / - f r S d f f . ' e j& A * fi /st CiA p t. X*A$* S r u < fA ( A Pi f'< S C ? / eJ ' Q y c? f /* Os l \ / / , ,r /Y / e v S y "/ / '/ '? .`: ~ c , L u ^ r/ /o 1. R E S E R V E S A M P L E 2. D A T E REPORTED 7 7 / . 7*7 / ty ^ A / ' / ! i - 4 ., L 5. P R O G R A M D A T A O P E RA TIO N P M S NO. PR O BLEM H IA /D C C NO. m L ^ N iiM B E R 13c. P C 14. a. B Y *mf METHOD/ CACULA- TION CHECK b. D A T E OTS HOURS (A.) fz; m acroscopic r~l X . - R A Y f F ; ("m ; [ ^ m i c r o s c o p i c FI E L D E X AM (PJ PHY EXAM fB .) B A C T f O ) I |o R G A N (C) CHEM (T V) w / O A N A L (X ) 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. AN ALYST WORK SH EET 3. S E A L S Q INTACT pfeRO KEN I 1n o n e 7. D E S C R I P T I O N OP S A M P L E 1. P R O D U C T 4. D A T E R E C D '/c <- r*i , ,, 5. R E C E I V E D P R O M C'JcAs/ ' . / . . _ 2. S A M P L E N U M B E R 6. D I S T R I C T OR D IV IS IO N 0 c-yA 8. NET CON- TENTS 1 1NOT A P P L I C A B L E N O T DETERMINED UNI TS E X AMI N ED D E C L A R E D/UNIT AMOUN T FOUN D % O F DE CL A RED 9. LABEL ING ) o r i g in 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 I NONE 10. S U M M A R Y O P A N A L Y S I S / ?. 3- 7, T * fe -- O&3,r. </>C'i't & / c A-c O / 3- ('/ L CiP A Aj t* /? 0 A C c / / * t 4 /A / /f )/ O ' (A"AiA r / A-e~ / If C>A / "v ^ ) // L. " l 1* (/ 7 /* L>/ 7 C7 l ( K cT. A ft / S o ,/? CrJCr c & f 1/ C */ i i: - C tr e t y'A ( r f /")?#? 7/ / >'</ s a ~/~ w / f 11. R E S E R V E S A M P L E 12. D A T E REPORTED /0 7 / - ! . f U ^ y / Lj 15. P R O G R A M D A T A 13a. A N A L Y S T (e j N A M E . /- l OP ERA TION JEM S NO. 1. PRO BLEM H IA / D C C NO ~ ~ f ? ------ - 13b. N U M B E R V"... 13c. P C 14. METHOD/ CACULA- TION I CHECK b. D A T E A C T I V I TY NO. ,0TS HOURS METHOD ( C h e c k no m ore t h e n tw o ) ____ (A) m a c r o s c o p i c (M) ' mi c r o s c o p i c (X) [~)X.-RAY (F) F IE L D EXAM (P) PHY EXAM C B ; Q b ACT (O) 1 ORGAN (C) CHEM (N) Q W / O ANAL ( 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 O F PAGES. A N A L Y S T WORK S H E E T 1. P R O D U C T I/ "3" S E A L S Y t T r 'c r |4. D A T E R EC D P^Tb ROKEN I I NONE 7. DESCRIPTION OP SAM PLE ft,/ c u a 1 . , v (C_ |5. R E C E I V E D F R O M / X? 2. S A M P L E N U M B E R 6. D IS T R IC T OR DIVISIO N T Cs t** < / -/o e-y NET CON TENTS | | NOT A P P L I C A B L E | NOT D E T E R M I N E D UNITS EXAMINED 10. S U M M A R Y O F A N A L Y S I S D E C L A RED/UN1 T AMOUNT FOUND % O F DECLA RED 9. LABEL ING | | ORI GINA LlS) 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 | | N ON E T/ * f c . L /*. AC *77 0 C2-? fP 'fir S o Q />:- '/ / 4 ;^ ' / -C /? / v 4 / // / _ / / , / 7 * siO C > n A v O / 7 <5 / y . . n f / '/ tc cv / O ' v ^ - // 1 ;I /( . v Av -S' 7 .;i t ' . / - (; ' . ,v r ' f f -< f / - / `' f r i ' * < ` C/ / / <3?> - / /^ 11. R E S E R V E S A M P L E 12. D A T E REPORTED 7 J<*/y 7 if 13a. A N A L Y S T f e ; NAM E . , // _________ *___t_____________________- . N '' ,v . . ( 131?t N U M B E R l/ 4 13c. PC T T ; METHOD/ CACULATION 1 CHECK a. BY b. D A T E 15. p r o g r a m d a t a 2 M L J 1 L , ______P R O B L E M 2. O P E R A TION H 1A / D C C N O A C T I V I TY NO. METHOD (C h e ck no more then two) (A) MACROSCOPIC (M) f7>TMICROSCOPI C ( X ) [ 7 ] X.-RAY (F ) | | FI E L D EXAM (P ) P7) P R Y EXAM f B j Q B A C T ( O ) I |p R G AN (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 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 . P A G E O F PAGES.