CONG HOA XA HOI CHU NGHIA VIET NAM pOC LAP - TY DO- HANH PHUC seen BAN TU CONG BO SAN PHAM 86; 28/TRUNGNGUYENLEGEND/2018 I. THONG TIN VE TO CHUC, CA NHAN TY CONG BO SAN PHAM: Doanh nghigp : CONG TY CO PHAN TAP DOAN TRUNG NGUYEN Tong Gidm Déc : DANG LE NGUYEN VU ‘Dia chi : 82-84 Bui Thj Xuan, phudng Bén Thanh, quan 1, TPHCM. Dign thoai 3 0283.9251845 - 0283.9251846 Fax : 0283.9251847 E.mail office@trungnguyenlegend.com MA sé doanh nghigp: 3700544850 Sé gidy chimg nh4n co sé di diéu kién ATTP: 000270/ATTP-CNDK, Ngay ep: 31/03/2017, Noi cp: Chi Cuc An Toan Thye Pham Ma sé doanh nghigp: 0304324655 - 006 Sé6 gify ching nhfn co sé dii diéu kién ATTP: 000324/ATTP-CNDK, 25/04/2017, Noi ep: Chi Cue An Toan Thye Phim. Ngiy ef Il. THONG TIN VE SAN PHAM: 1. Tén San Phim: CA PHE HOA TAN G73 IN 1 X2 2. Thanh phan: Dudng, bot kem, ca phé héa tan, maltodextrin, mudi. 3. Thoi han sir dung: 24 thang ké tir ngay sn xuat 4. Quy céch déng géi va chat ligu bao bi: - San phim duge déng g6i kin, khong tiép xtc voi khéng khi bén ngoai. - Khéi lurong tinh: 25 g, 30 g, 50 g, 100 g, 500g, 1 kg, 2 k; - Thanh phdm duge déng goi trong hép git iy, tai phire hgp, hu nhwa, thing gidy hoc bao PE véi cde quy cach yéu edu tir th trum) Vv5. Tén va dja chi co sé sain xuit san phi A: Cong Ty CP Ca Phé Hoa Tan Trung Nguyén. Dia chi: Khu A, KCN Tan Déng Higp, P. Tan Dong Higp, TX Di An Tinh Binh Duong, Vigt Nam. C: CN Céng Ty CP T§p Doan Trung Nguyén — Nha May Ca Phé Sai Gon. Dja chi: LO A, duimg NAT, KCN Mg Phuéc 2, Bén Cat, Tinh Binh Duong, Vit Nam (Noi san xudit dug mda héa va ghi bén canh han sit dung) 11. MAU NHAN SAN PHAM: (Dinh kém mau nhan sén phim) IV. YEU CAU VE AN TOAN THUC PHAM: Phi hop véi quy dinh an toan thye pham: = Quyét dinh 46/2007/QD - BYT: Quy dinh gidi han t6i da 6 nhi&m sinh hoc va héa hoc trong thye phim. - QCVN 8-1:2011/BYT: QCKTQG gidi han 6 nhiém, déc t6, vi nim trong thye phim. - QCVN 8-2:2011/BYT: QCKTQG giéi han 6 nhiém kim loai nang trong thye pham. 1. Cée chi tigu cm quan: * Trang thai: Dang bét, khong von cuc. = Mau sic : Dac trung, = Mai : Thom ca phé dic trung, khong mii la. "Vi : Dac trung, khong vi la. 2. Cae chi tiéu héa ly: STT TEN CHi TIEU DVT | MUC CONG BO CHAT LUQNG 1 |Doam % <5 2__| Ham lugng Caffeine % 20,25 3_| Ham hong Saccharin [ppm 0 4 _ | Ham lugng Melamine ppm 0 &3. Cac chi tigu vi sinh: STT TEN CHi TIEU DVT | MUC CONG BO CHAT LUQNG 1 | Téng sé VKHK cfwg <10" 2 |S. Aureus cfwg =10 3. |B. Cereus cfug =10 4 _| Coliforms fue <10 3__[Ecoli cfu/g 53 : 6 | Cl. Perfringens cfu/g =10 7__ | Salmonella cfw25g 0 8 | Tong sd BT ndm men, nam méc | cfg =10" 4, Ham lwgng kim logi ngng: STT TEN CHi TIEU DVT | MUC CONG BO CHAT LUQNG |_| Ham lugng Asen (As) mgikg 1 2__| Ham lugng Chi (Pb) mg/kg $2 3__| Ham lugng Cadimi (Cd) mg/kg SI 4_| Ham lugng Thiy Ngan (Hg) mgikg 0,05 3__| Ham lugng Dong (Cu) mgkg <30 5. Déc t6 vi nim: STT TEN CHi TIEU DVT | MUC CONG BO CHAT LUQNG |__| Ham lugng Ochratoxin A ppb <10 Ching tdi cam két thye hign day di cdc quy dinh cia phdp luat vé an toan thye phim va hoan toan chju trich nhiém vé tinh phap ly cia hd so cng bé va chat lugng, an toan thyc phim déi véi san pham da céng bé. Tp Hé Chi Minh, ngay 18 thang 12 ndm 2018 a TONG GIAM poofCONG TY CP DV KHOA HOC CONG NGHE CHANNAM \VP: 80-82-84 Thang Long. P., 4, @. Tan Binh, Tp. HCM #1 PNM & TN: 176/9A 18 Van Sf, P. 10, @. Pha Nhugn, Tp. HCM ign thogi 028.39911131 - 028.3691 132 - Holtine: 0901372755, mall info@'channarn com.vn - Webbite: wwrw.channam.corn vn VILAS 677 ‘S6/No: 18111161-I/KQ a 7 ce KET QUA THU NGHIEM TEST REPORT ‘Ma s6 (ID.): 18110942/1811366 Tén khiich hang: CONG TY CP TAP DOAN TRUNG NGUYEN Client TRUNG NGUYEN COFFEE CORPORATION Dja chi: 82-84 Bai Thj Xun, Phuong Bén Thinh, Quan 1, Thanh phd Hd Chi Minh Address 82-84 Bui Thi Xuan Street, Ben Thanh Ward, District 1, Ho Chi Minh City. Ngay nh§n mau: 22/11/2018 Thai gian thir nghigm: 22-30/1 1/2018 Date of receiving Test duration : Ngay tra két qua: 30/11/2018 Date of returning E Logi miu: Ca phé Sé lugng: o1 Kind of sample Coffee Quantity: Tén mau: CA PHE HOA TAN G7 3INI X2 Name of Sample G7 INSTANT COFFEE - STRONG X2 COFFEE MIX 3INI Tinh trang mau: Thanh pham State of Sample: _ Finished product 1T CHi TEU KET QUA | DONVI| PHUONG PHAPTHU No. SPECIFICATION RESULT UNIT METHOD 01 | DO am/ Moisture (*) 2,07 % | FAO,14/7,1986 02 _| Tro ting / Ash (*) 2,66 % | FAO,14/7,1986 03 | Chisé peroxyt / Peroxide (LoD=02) _ | mea/kg | TK-TCVN 6121 : 2010 04 | Caffeine (*) 0,28 %_ | TCVN 9723:2013 05 | Ochatoxin A a pg/kg | TCVN 9724 : 2013 (LOD=1,0) KPH /ND CASE.SK.0019 (Lop=2)__ | ™/Ke | aaPLc) 06 | Saccharine +» KPH /ND 7 ETC : 07 | Melamine (Lob) __| melke | ReTCVN 9048: 2012 mF CASENS.0037 (ReEAOAC 08 | Lecithin <0,05 % _| 949.07&€AOAC 923.07) Chichi: Chi igus 06-08 diag tes hig BoA nhs thu pi. Note Tems number 06-08 was analysed by the subcontractor oa Phy trach PIN Tran Thyy Thanh Thao 1, KE: qua may chi od gid ey orém mau tae / This testing results only valid on tested sample 2. Thing tin mdudo Which hing cums edp / Sample information was provided by the customer ) Chiu are VILAS cnt nh em was crated LAS hi eu date Cuc An Todn Thuc Phin (BO ¥ TE) cht dink/ rem was assigned by Viemam Food Administration (Ministry of Health ‘Khing phit hin / ND: Not detected, LOD: Cid hon pt hin! Limt of detection Eanes Believe in CHAN NAMEmail CONG TY CP DV KHOA HOC CONG NGHE CHANNAM GER Rs, ks a LG) PNM & TN: 176/9A Lé Van Sy, P. 10, @. Phd NhuGn, Tp. HCM. VS Ly ‘VP: 80-82-84 Thang Long, P, 4, @. Tan Binh, Tp. HOM. fil Y) —~s /3} ign thoal: 028.39911131 ~ 028.39911132 - Hotline: 0901372755 gm info@channam.com.vn - Website: waww.channam.com.vn vis E VILAS 677, (CHAN NAM TSS S6/ No: 18111161-3/KQ KET QUA THU NGHIEM TEST REPORT MA sé (1D.): 18110942/1811366 CONG TY CP TAP DOAN TRUNG NGUYEN Tén khich hang: Client TRUNG NGUYEN COFFEE CORPORATION Dia chi: 82-84 Bai Thi Xuan, Phuong Bén Thanh, Quan 1, Thanh phé H6 Chi Minh Address 82-84 Bui Thi Xuan Street, Ben Thanh Ward, District 1, Ho Chi Minh City Ngay nbn méu: 22/11/2018 This gian thir nghigm: 22-30/11/2018 Date of receiving Test duration : Ngdy tra két quit: 30/11/2018 Date of returning : Loai miu: Caphe Sé lugng: o1 Kind of sample Coffee _ Quantity: Tén miu: CA PHE HOA TAN G73INI X2 Name of Sample G7 INSTANT COFFEE - STRONG X2 COFFEE MIX 3IN1 Tinh trang mu: Thanh phim State of Sample; Finished product TT CH TIEU KETQUA | DONV] | PHUONGPHAPTHO SPECIFICATION RESULT _|_UNIT ‘METHOD 01 | Arsen / Arsenic (As) : TORE mghkg | AOAC 986.15 a KPH/ND 02 | cadimi / Cadmium (Cd) | cKop-oor | ERE | AOAC 999.11 03 | Chi /Lead (Pb) (*) 0,051 mglke | AOAC 999.11 ; KPH/ ND 04 | Thiy ngin/ Mercuyr(He) | rop-oon | mes [AOAC 974.14 05 | Dang / Copper (Cu) (*) 0,30 mg/100g | AOAC 999.11 Phy trach PIN Laboratory ae Tran Thyy Thanh Thao ONG TY CO PHAN 1, Kei qu my chic de ten mc tt Ts esting res ony val on tested sample 2 Thing in mu do thick hang cane cp Sample fara was provided bythe cuomer iar M78) 1/07/2018 iti date VILAS cng nhin / lem was accredited by VILAS de Cue An Toa Tac Pin (8) ¥ TE) cn Tem was aslened by Vemam Food Adminstration (Ministry of Heath) ‘Khéng phit hign / ND: Not detected, LOD: Gidi han ' es rj ciate ha hien Limit of detection. Believe in CHAN NAMCONG TY CP DV KHOA HOC CONG NGHE CHAN NAM 7 ~ (@ \ Ve ate2s4Tranglong. P46 Ton Te HOM fe ° PNM & TN: 176/9A Lé Van SY, P. 10, @. Phi NhuGn, Tp. HOM sa oy, ign thogi: 028,3991 1131 - 028.39911132 - Hotline: 0901372755 Email info@channam.com vn - Webste: www chan c panty: Eee OR oOo. Spee ak aaa VILAS 677 S6/ No: 18111161-2/KQ z 5 KET QUA THU NGHIEM TEST REPORT MA sé (ID.): 18110942/1811366 Ten khich hing: CONG TY CP TAP DOAN TRUNG NGUYEN Client TRUNG NGUYEN COFFEE CORPORATION Dia chi: 82-84 Bui Thj Xuan, Phuong Bén Thanh, Quén 1, Thanh pho Hé Chi Minh Address 82-84 Bui Thi Xuan Street, Ben Thanh Ward, District 1, Ho Chi Mink City. Negay nbn miu: 22/11/2018 ‘Thoi gian thir nghigm: 22-30/11/2018 Date of receiving Test duration : Ngay tra két qua: 30/11/2018 Date of returning Logi mau: Ca phé Sé lurgng: on Kind of sample Coffee | Quantity: Tén miu: CA PHE HOA TAN G7 3IN1 X2 Name of Sample G7 INSTANT COFFEE - STRONG X2 COFFEE MIX 3IN1 Tinh trang mau: Thanh phim State of Sample: _ Finished product 1T CH TEU KET QUA | DONV]] PHUONGPHAPTHU No. SPECIFICATION RESULT UNIT METHOD Tong s6 vi khugn hidu khi i) 2 +, | TOWN 4884-1:2015 Ol | ‘Total Plate Count bie CFUIg | aso 4833-1:2013) aren Khong phat hien TCVN 68482007 G2 | Collforms Notdetected | CFU'® | aso 4s32:2007) leek it Khong phat hign TTCWN 7924-2:2008 eee Not detected _| “U8 | aso 16649-2:2001) bs hiss TCVN 4830-1 : 2005 04 | Staphylococcus aureus *\() er CFU/g | (80 6888-1 : 1999 with Cones amd 1:2003) a ; Khong phat hign TCVN 4991 : 2005 5 | Clostridium perfringens Notdetected | PU'® | (18079372004 * Khong phat hign TCVN 4992 : 2005 06. | Bacillus cereus (*\i) feng phat bite | CFUIg | (50 79322004) o7 | Tong 36 bao tirndm men- méc (*yi) | Khong phat hign | Cpryy | TCVN 8275-2:2010 © | Yeast and Mould Not detected '& | aso 21527-2:2008) Am tinh’ TCVN 10780-1 : 2017 ee Negative 238 | aso 6579-1 :2017) Chichi: Chiu 3B 01-07 o6 ngung ph hi Nowe ems number 01-07 limit of detector Phy trich PTN Laboratory Manager = " Nera Trin Thyy Thanh Thio 1 Rut ay dg ren ma Ta tig es oval nel mp 3 Ey ici i dure VIAS cong tide lem wat acceded HAS ne utomer Km King pat hn ND! Nt etected LOD: Gui hen ph i Lim ferro nn Namnstranion (Misr of Meath 7.8/1 01/07/2008 ———S Believe in CHAN NAM\VP: 80-82-84 Thang Long, P. 4, @. Tan Binh, Tp. HCM PNM & TN: 176/94 Lé Vén Sy, P. 10, @. Phd Nhuan, Tp. HCM fe Dy ign thoat: 028.39911131 - 028.39911132 - Hotline: 0901372755 mall: nfotichannom.com vn - Webstle: ww.channam com vn “umes ¢ a CONG TY CP DV KHOA HOC CONG NGHE CHAN NAM ) ” CHAN NAM TS3 SOINo: 18111161-5/KQ a i KET QUA THU NGHIEM TEST REPORT ‘Ma s6 (ID,): 18110942/1811366 (Trang/Page: 1/2) Ten khach hang: CONG TY CP TAP DOAN TRUNG NGUYEN Client TRUNG NGUYEN COFFEE CORPORATION Dja chi: 82-84 Bui Thj Xuan, Phuong Bén Thanh, Quan 1, Thanh phé Hd Chi Minh Address 62-84 Bui Thi Xuan Sireet, Ben Thanh Ward, District ], Ho Chi Mink City. Ngay nhgn mu: 22/11/2018 Thoi gian thir nghiém: 22-30/11/2018 Date of receiving Test duration : Ngay tra két qua: 30/11/2018 Date of returning Loai mau: Ca phe S6 Ingng: 01 Kind of sample Coffee Quantity: Tén mau: CA PHE HOA TAN G7 3INI X2 Name of Sample G7 INSTANT COFFEE ~ STRONG X2 COFFEE MIX 3INI Tinh trang mau: Thanh phim State of Sample: Finished product Két qua: Trang 2/2 Result: Page 2/2 Phy trach PIN Laboratory Manage a Tran Thyy Thanh Thio qu ny che item nd tht / This testing results only valid on ested sample ‘ung cdp / Sample information was provided by the customer nin Yom wat accredited by VILAS tae Cue An Toan Thue Pham (B0 ¥ Te) chi din /lem was assigned by Viemam Food Administration (Ministry of Health) IKPH: Khng phat hién/ ND: Not detected, LOD: Git hon pht Men’ Limi of detection 1M 78/1 01/07/2018) Believe in CHAN NAM.TT CHI TIEU No.| SPECIFICATION 01 aa ae 114 keal/25g 02 Bee bse a i 33 kcal/25g _ | Included testing fat 03. | Béo/ Fat (*) 3,68 gi25g | FAO, 14/7,1986 04 | Béo bao hda/Saturated fat 1,32 w/25g | AOAC 966.17 os | Transfat Goma) mg/kg | Ref AOAC 996.06 06 | Protein (Nx6,25) (*) 1,00 225g __| FAO, 14/7,1986 07 | Total Carbohydrate 19.2 g25g | TK.AOAC 986.25 08 | Duong / Sugar (*) Ml g/25g | TCVN 4594-1988 09 | Dietary fiber 1,53 25g | AOAC 991.43 10 | Natri/ Sodium (Na) 102 mg/25g_| AOAC 969.23 11 | Canxi /Calei (Ca) 10.0 mg/2sg | AOAC 968.08 Via | Fer sron oe) () 022 mg/2sg__| AOAC 999.11 13 | Kali / Potassium (K) 186 mg2sg__| AOAC 969.23 14 | Cholesterol Gene) mgkg | Ref AOAC 994.10 [ 15 | Yiamin Ds iteaay mykg | TCVN8973: 2011 Chi tibu s8.05,09, 14 dae tec hign boi nha thau phy. Items number 05,09,14 was analysed by the subcontractorMa sé (ID.): 18110942/1811366 CA PHE HOA TAN G7 348 Ts ‘Serving Per Container Total Sugars Protein 1,02 Vitamin D Omeg Iron 0,2mg Serving size 25g ‘Amount Per Serving Calories 114 h Daily Value * Total Fat 4g 6% Saturated Fat 1g ™ Trans Fat Og ‘Cholesterol Omg 0% Sodium 102mg 4% Total Carbohydrate 19 2 ™% Dictary Fiber 1,5 Calcium — 10mg Laz] | at 1% 1 serving of food contributes toa daily diet 2,000 calories a day is used for general nutrition advice Potassium 186mg 5% * The % Daily Value (DV) tells you how much a nutrient in 4 Believe in CHAN NAMCONG TY CP DV KHOA HOC CONG NGHE CHANNAM Ss VP: 80:82:84 Thang Long, P. 4, @, Tan Binh, Tp. HEM PNM & TN: 176/9A Lé Véin S9, P. 10, @. Pha Nhudn, Tp. HCM Ex ign thoal: 028.39911131 - 028.99911132 - Hotline: 0901372755 gS Email info@channam.com.vn - Website: www.channam.com.vn “unmare S6/No: 18111161-4/KQ F a . i KET QUA THU NGHIEM TEST REPORT Ma s6 (UD.): 18110942/1811366 (Trang/Page: 1/2) Tén khdch hang: CONG TY CP TAP DOAN TRUNG NGUYEN Client TRUNG NGUYEN COFFEE CORPORATION Dja chi: 82-84 Bui Thi Xudn, Phudng Bén Thanh, Quén 1, Thanh phé Hé Chi Minh Address 82-84 Bui Thi Xuan Street, Ben Thanh Ward, District I, Ho Chi Minh City Ngay nhiin miu: 22/11/2018 Thdi gian thir nghi¢m: 22-30/11/2018 Date of receiving Test duration : Ngay tra két qua: 30/11/2018 Date of returning Logi miu: Ca phé S6 long: ol Kind ofsample Coffee Quantity: Tén mau: CA PHE HOA TAN G7 3INI X2 Name of Sample G7 INSTANT COFFEE - STRONG X2 COFFEE MIX 31N1 Tink trang mau: Thanh phim State of Sample: Finished product két qua: Trang 2/2 Result: Page 2/2 Phy trach PIN Tran Thyy Thanh Thao 1. KE: qui may cht cd eid ro aren mu ht This testing result i ony valid on tested sample 2. Thang iin mdudo thch hang eung cdp /Sample Information was prosided bythe customer 3. (*) Chi tien due VIEAS cOng whan / lem was accredited by VILAS 4. (GLH te de Cuc An Tea The Pham (BD Y TE) oh din / Tem was asigned b [KPH Khong phir hén/ ND: Nor detected, LOD: Gidi han phat hin Limi of det aM 7.8/1 (01/07/2018) nar Food Administration (Ministry of Health) Believe in CHAN NAMfar] caititu \ SPECIFICATION RESULT ae ee 02 be ah pee he 132 keal/100g | Included testing fat 03 | Béo/ Far (*) 147 % | FAO, 14/7,1986 04 | Béo bao hda/Saturated fat 5,29 % | AOAC 966.17 05 | Transfat RoRetON mg/kg | Ref AOAC 996.06 06 | Protein (Nx6,25) (*) 4,01 % | PAO, 14/7,1986 07 | Total Carbohydrate 167 % | TK.AOAC 986.25 08 | Dudng / Sugar (*) 56,5 % | TCVN 4594-1988, 09 | Dietary fiber 61 % — | AOAC 991.43 10 | Natri) Sodium (Na) 406 mg/100g | AOAC 969.23 11 | Canxi /Caleé (Ca) 40,1 mg/100g | AOAC 968.08 12 | Fe/ Iron (Fe) (*) 0,86 mg/100g | AOAC 999.11 13 | Kali / Potassium (K) 744 mg/100g | AOAC 969.23 14 | Cholesterol tomo) mglkg | Ret AOAC 994.10 1s | Vitamin D3 (open) | mks | TCVN8973: 2011 Chi Tiéu 58 05,09,14 dhage thee hién boi nha thaw plu. Items number 05,09,14 was analysed by the subcontractorServing Per Container Serving size ‘Amount Per Serving Calories 455 % Daily Value * Total Fat 17g 23% Saturated Fat 5,3g 26% Trans Fat Og Cholesterol mg 0% ‘Sodium 406mg 1™% Total Carbohydrate 77 26% Dietary Fiber 61g 24% Total Sugars 56,5 i Protein 4,03 ‘Vitamin D Omeg 0% TP * The % Daily Value (DV) tells you how much a nutrient i] 1 serving of food contributes to a daily diet 2,000 calories a day is used for general nutrition advice Caleium 40mg ¥% Iron 0,8mg 5%] Potassium 744mg 21% Believe in CHAN NAMHop quy cic 12 stcg/tGpo ABSORB Tder*ch em) come 105mm 60mm L105 6mm Ayreon hue | Lb ten Nore Nhutin4 TRUNG NGUYEN (© Duc chgn loc tihng nguyen gu tt tren thé i, vel cing nghé hig dai v8 bi quyt tng thé 520 chép cia Tung Ngeyén, ching ti tao ra m6t loa phd hod tan G7 Gu Manh gp 46, dinh cho inhing nguti thd thigt cé cé tinh manh mé, dem ) an