Gluten Test Record

Test Date:__________________________________

Test Time:__________________________________

Partner Name/Ingredient Brand Name:_______________________________________________________

Product Name/ Ingredient Name:____________________________________________________________

Product/Ingredient Description:_____________________________________________________________
List this as it is on the GFCO certificate or Product & Ingredient list.

Product/Ingredient Lot Number:_____________________________________________________________

Item Type:(Circle One) Finished Product / Ingredient / Equipment Test

Testing Method:
Test Kit Lot#/Expiration-____________________________________________________________________
Dilution Solution Lot#/Expiration-_____________________________________________________________
Test Strip Lot#/Expiration-___________________________________________________________________
Extraction Solution Lot#/Expiration____________________________________________________________

Result:__________________________________________________________________________________
Positive or Negative at 10ppm or 20ppm

Test Performed by:______________________________________Date______________________________

Notes:

Reviewed By/ Date:

Ideation 1
1500 Marietta Boulevard NW, Atlanta, GA, 30318.
SQF version 9.0.
QF-050
Issued: 11.17.18/2.27.20/5.14.21/7.3.21/12.8.22/1.8.23
Version: F