c.
SUB
ELEMENT
ATOMIC
ABSORP.
ELECTRO
PHOTO-
METRIC
CONTAINER:
RESULTS
2. SAMPLE NUMBER
% OF DECLARED
FORM FDA 431m (12/79)
6. DISTRICT OR LABORATORY
__ UNITS EXAMINED
QUANTITATION (PPM)
LABEL-
ING
PRODUCT:
CODE:
a. METHOD
AOAC
d.
e.
f.
WORK-
SHEET
CHECK
d. ADDITIONAL INFORMATION
13.
b. SAMPLE PREPARTION & COMPOSITE (Reference/Date)
11. RESERVE SAMPLE
14. DATE REPORTED
a. BY
REC’D PREPARED
12. a. ANALYST SIGNATURE (Broke Seal
)
b. DATE
c.
b.
NONE
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PREVIOUS EDITION IS OBSOLETE
ATTACH. ____ - ____
Created by: PSC Media Arts (301) 443-2454
EF
ELEMENTAL
ANALYSIS WORKSHEET
1. PRODUCT
NET
CONTENTS
3. SEALS
4. DATE REC’D
5. RECIEVED FROM
7. DESCRIPTION OF SAMPLE
8.
10. SUMMARY OF ANALYSIS
NONE
INTACT
9.
BROKEN
NOT DETERMINED
AMOUNT FOUND
NOT APPLICABLE
DECLARED UNIT
ORIGINAL (S) SUBMITTED
COPIES SUBMITTED