CUSTOMER/LOCATION: ____________________________________________________________ FILE NO.

: ____________

DATE: __________________________________________ TESTED BY: __________________________________________

FOAM CONCENTRATE TYPE / LOT NO.: ____________________________________________________________________

CALIBRATION STANDARDS

STANDARD SAMPLE REFRACTIVE INDEX

FOAM CONCENTRATE

WATER

PREMIX #1 ( )

PREMIX #2 ( )

PREMIX #3 ( )

CALIBRATION CURVE
PERCENT FOAM SOLUTION

REFRACTIVE INDEX
SYSTEM DISCHARGE SAMPLE REFRACTIVE INDEX PERCENT FOAM SOLUTION

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ANSUL INCORPORATED, MARINETTE, WI 54143-2542 715-735-7411 Form No. F-8822 ©2000 Wormald U.S., Inc. Litho in U.S.A.