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METALLOGRAPHICA LYSIS DATAS <br /> NALCO <br /> t <br /> This form must be completed and accompany each sample the failure. Submit the sample in the same condition as <br /> submitted for metallographic analysis.The accuracy of the when removed from the system. Do not chemically or <br /> diagnosis is dependent on the information included and the mechanically clean, scrape, or alter the appearance of the <br /> quality of the sample submitted. At least a portion of the sample after removal Rush requests must have the <br /> failed area as well as a portion of unaffected metal must be approval of the Consulting Department, Naperville, and <br /> submitted with the sample.Avoid torch cutting if possible. If must be shipped priority mail. <br /> a torch must be used,cut at least 8 inches on either side of <br /> Company pn S V-o w Q <br /> City State C Sampling Date —71/&'A S <br /> Send A_Copies To Copies To District No. <br /> Your Name 4 fil Telephone No.(,�L0;1 ±2 <br /> Signature of the District Manager must accompany this request: <br /> Describe the Nature of the Problem 1 ( (' <br /> AU ci lni�n��� �I hrb � iPi O� -)c� i� sC IJ 1 /cnSTP(' <br /> From what kind of process,system,or equipment was this sample removed? <br /> Ac , g t!Cns1 e.� .o�eo) <br /> Where in this process,system,or equipment was this sample taken? <br /> S I?r--t F(aM �}.P �C ; -fry <br /> What is the function of this sample in the process,system,or equipment? / <br /> rar , C 1 d 1O 1'l)li,Pr cictI K <br /> 71�e <br /> icy ra c r C� Z, , �� ;-\s k <br /> Is this problem occurring generally throughout the system or is it localized to some specific area? <br /> I o cc 1 1 ?e U rA-t i,.,e. l J <br /> How many failures of this type have occurred? 0 rt I <br /> Is this problem recent? Recurrent? f`P Cen`t <br /> What specific information is needed? <br /> ® N n r- n-+e Jj)"C; s <br /> 1 i 1 <br /> * N-OP ttf *.-0 ):'no L--, �oI� �I L.' e. S)w✓1� l c Ve )?e-1 neve i4e <br /> ` J <br /> Form 655(1.86) NALCO CHEMICAL COMPANY <br />