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tee

sy

navel fiat

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betel, eck gore oe:

» TATU Pier SURVEY

|

|

INDIVIDDAL, WEOICAL A PLET QUECHONNAIRE

PGE 2 oF &

DIETARY INT>FoUTON
Trestrectinns :

—_ ,

of nt webriuction based on actu by feriouia at Uf of

Abell, Fediclines of the

diet at Toatel after reset eneuet irl Ieee ex! wy

+ Sefiaute moult a0 aeeurstely ar possible, TH mals!
o fer all ostinases of quastites, tu2 the

12 oumee. Soff drink can an the stedarel

eit of measurement for al| toed aud beverage

substecced. eventhi

: bread nell

ceapwut wear, omc} juice ale. Rreerd aumorels as 1, or more yor iu thnDeak) 255 [55 as

+ De not Praqarrdle fey aug teason|

.

.

peat om domestic fe sften. We will te onfncte He
peeesatay
Fie of Hausition
NokwaAL te Famine pride fhe NORMAL. aud FAMINE

» Famine. cortitiqn. ae the se tins whee. becaute of [ack of fold tp Setvice. ,

dicho uration collected hy thas 4
o All free Columues ae &

iounarye .

be consplefed for each, tod aud beverage eux

Day | WEEK, ¢ MonTiL, we. fer cack. item which A Au “het consumed hy The

person

lepoog .

FAMING

NoRm AL

CONDITIONS

CONDITIONS

NAME OF

CoNSUMProe®s RATE

Cons UmPTon RIFTS

Mtrowbeot

bo LL

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DRMETIC_AGRICUCTIZALPROONCIS.

\s

Aaoef Met tek aaa t

Annet Auseed

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Feod TEM

Week | test
/

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:
f

ni

CheLOO_o te OT
LEnele

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het Cevpra) (hat
Midd'e caed

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(ada LOIa
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wk
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fo

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107 1,25 8%Ler | 6 ea

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DD DL
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to
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