SPSFAM Heavy Metals ERP Book

AOAC FIRST ACTION 2015.01

MULTI LABORATORY TEST

Annex D: Receipt Forms

Name Laboratory Country

Sample

Code

MLT Sample 1 MLT Sample 2 MLT Sample 3 MLT Sample 4 MLT Sample 5 MLT Sample 6 MLT Sample 7 MLT Sample 8 MLT Sample 9 MLT Sample 10 MLT Sample 11 MLT Sample 12 MLT Sample 13 MLT Sample 14

1718-0095.5118051.1 1718-0095.5118055.2 1718-0095.5118073.3 1718-0095.5118075.4 1718-0095.5118078.5 1718-0095.5118080.6 1718-0095.5118083.7 1718-0095.5118091.8 1718-0095.5118118.9 1718-0095.5118120.10 1718-0095.5118122.11 1718-0095.5118124.12 1718-0095.5118126.13 1718-0095.5118128.14

Date of Receipt All Items received undamaged

Yes/No Yes/No

Items missing/damaged

List missing /damaged items needing replacement

Please email the completed form to:

Rick Reba Nestlé Quality Assurance Center E-mail: rick.reba@us.nestle.com

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