Number range CHAPTER **Form FFC-2b. Chemical Use Log for Clinical Field
Trials Using Aquaflor^TM^ (FFC) as a Feed Additive Under INAD #10-697 -
[Treated Feed]{.underline}**

**[Instructions:]{.underline}** 1. Initiate Form 2 immediately upon
receipt of Aquaflor^TM^ treated feed.

2\. Each lot number of Aquaflor^TM^ treated feed should be used for a
single treatment regime.

3\. A signed copy of Form 2 should be sent to the Study Monitor at the
end of the Study Year.

4\. Original Form 2 should be archived at the investigating facility.

**Quantity on Hand Reporting**

**From Previous Page (lbs): \_\_\_\_\_\_\_\_\_\_\_\_\_\_ Facility:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Individual:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

<table style="width:100%;">
<colgroup>
<col style="width: 11%" />
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<col style="width: 9%" />
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</colgroup>
<tbody>
<tr class="odd">
<td><strong>Aquaflor<sup>TM</sup> Treated Feed Lot Number and %
Premix</strong></td>
<td><p><strong>Date</strong></p>
<p><strong>Received</strong></p></td>
<td><strong>Amount Received (lbs)</strong></td>
<td><strong>Dates Used</strong></td>
<td><p><strong>Study</strong></p>
<p><strong>Number</strong></p></td>
<td><p><strong>Aquaflor<sup>TM</sup></strong></p>
<p><strong>Treated Feed Used for Teatment (lbs)</strong></p></td>
<td><p><strong>Aquaflor<sup>TM</sup></strong></p>
<p><strong>Treated Feed</strong></p>
<p><strong>Shipped<sup>1</sup> (lbs)</strong></p></td>
<td><p><strong>Aquaflor<sup>TM</sup></strong></p>
<p><strong>Treated Feed</strong></p>
<p><strong>Disposal<sup>2</sup> (lbs)</strong></p></td>
<td><p><strong>Aquaflor<sup>TM</sup></strong></p>
<p><strong>Treated Feed</strong></p>
<p><strong>On-hand (lbs)</strong></p></td>
<td><p><strong>Inventoried by</strong></p>
<p><strong>(initials)</strong></p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><strong>Shipped</strong></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
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<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
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<td></td>
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<tr class="even">
<td></td>
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<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
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<td></td>
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<td></td>
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</tr>
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</tr>
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</tr>
<tr class="odd">
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**^1^ Unused Aquaflor^TM^ treated feed that is shipped to another
facility participating in Aquaflor^TM^ INAD #10-697 ([Note]{.underline}:
Aquaflor^TM^ treated feed can only be shipped to another facility with
prior**

**authorization by the Bozeman National INAD Office).**

**^2^ Unused Aquaflor^TM^ treated feed that is disposed of by burial or
in a landfill.**

**Investigator: Study Monitor:**

**Signature and Date Signature and Date**