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WORK SHEET

Report No: Page 1 of 1


Discipline : Group:
CUSTOMER DETAILS
Customer Name & Address:

Customer Reference: NA
SAMPLE DETAILS

Sample Code : 23120189.16 Sampled On : NA


Sample Name : Coffee and Cocoa Products Sample Received On : 29/12/2023
Sample Description : Coffee Products Sampling Location : NA
Sample Condition : Good Sampling Procedure : NA
Sample Quantity : 100g Equipment Used : NA
Sampled By : NA Test Started On :
Customer Code : NA Test Completed On :

SL.NO TEST PARAMETER(S) TEST METHOD UNIT RESULTS

1 Caffiene

Analyzed By: Verified By:

CVR/QA/FRM/059 Issue No / Date : 02 / 02.11.2020 Page 1 of 4 Amend. No. / Date : 00 / --


WORK SHEET
Report No: Page 1 of 1
Discipline : Group:
CUSTOMER DETAILS
Customer Name & Address:

Customer Reference: NA
SAMPLE DETAILS

Sample Code : 23120189.17 Sampled On : NA


Sample Name : Coffee and Cocoa Products Sample Received On : 29/12/2023
Sample Description : Coffee Products Sampling Location : NA
Sample Condition : Good Sampling Procedure : NA
Sample Quantity : 100g Equipment Used : NA
Sampled By : NA Test Started On :
Customer Code : NA Test Completed On :

SL.NO TEST PARAMETER(S) TEST METHOD UNIT RESULTS

1 Caffiene

Analyzed By: Verified By:

CVR/QA/FRM/059 Issue No / Date : 02 / 02.11.2020 Page 2 of 4 Amend. No. / Date : 00 / --


WORK SHEET
Report No: Page 1 of 1
Discipline : Group:
CUSTOMER DETAILS
Customer Name & Address:

Customer Reference: NA
SAMPLE DETAILS

Sample Code : 23120189.18 Sampled On : NA


Sample Name : Fruit and Fruit Products Sample Received On : 29/12/2023
Sample Description : Apple Juice Sampling Location : NA
Sample Condition : Good Sampling Procedure : NA
Sample Quantity : 100ml Equipment Used : NA
Sampled By : NA Test Started On :
Customer Code : NA Test Completed On :

SL.NO TEST PARAMETER(S) TEST METHOD UNIT RESULTS

1 Synthetic Dyes

Analyzed By: Verified By:

CVR/QA/FRM/059 Issue No / Date : 02 / 02.11.2020 Page 3 of 4 Amend. No. / Date : 00 / --


WORK SHEET
Report No: Page 1 of 1
Discipline : Chemical Group:
CUSTOMER DETAILS
Customer Name & Address:

Customer Reference: NA
SAMPLE DETAILS

Sample Code : 23120189.19 Sampled On : NA


Sample Name : Fruit and Fruit Products Sample Received On : 29/12/2023
Sample Description : Hot pepper Bean paste Sampling Location : NA
Sample Condition : Good Sampling Procedure : NA
Sample Quantity : 100g Equipment Used : NA
Sampled By : NA Test Started On :
Customer Code : NA Test Completed On :

SL.NO TEST PARAMETER(S) TEST METHOD UNIT RESULTS

1 Benzoic acid

Analyzed By: Verified By:

CVR/QA/FRM/059 Issue No / Date : 02 / 02.11.2020 Page 4 of 4 Amend. No. / Date : 00 / --

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