Please Provide Results: Fax Email

Food Chemistry Chain of Custody EMSL ANALYTICAL, INC. 200 ROUTE 130 NORTH EMSL Order ID (Lab Use Only): CINNAMINSON, NJ 08077 PHONE: (800) 220-3675 FAX: (856) 786-0392

EMSL-Bill to: Same Different Company : If Bill to is Different note instructions in Comments** Street: Third Party Billing requires written authorization from third party City: State/Province: Zip/Postal Code: Country: Report To (Name): Fax #: Telephone #: Email Address: Project Name/Number:

Please Provide Results: Fax Email Purchase Order: U.S. State Samples Taken: Turnaround Time (TAT) Options* - Please Check TAT Options – Turn Around Time is calculated using business days 2 days 3 days 4 days 1 week 2 weeks 3 weeks 4 weeks *Analysis completed in accordance with EMSL’s Terms and Conditions located in the Price Guide Sample Matrix Solid Raw Processed Packaged Liquid Other (Please explain) *Please Contact Laboratory Prior to Sample Submittal for Sample/Shipping Requirements* Food Chemistry Analysis Nutritional Parameter* Other Requested Parameters¹ Protein (F202) Vitamin A (F212) Pesticides (call for details) Moisture (F203) Vitamin C (F213) Heavy metals (specify) Fat Profile (total fat, saturated fat, monounsaturated fat, trans fat from fatty acids) (F205) Pet Food (F219) Sugar Profile (fructose, glucose, sucrose, maltose, lactose) (F206) (Protein, Moisture, Crude Fat, Crude Fiber) Ash (F204) Cholesterol (F211) Pet Food Guaranteed (F226) (AAFCO Compliant Format: Fiber/Dietary total (F207) Calories by calculation** (F214) (Protein-Min, Moisture-Max, Crude Fat-Min, Crude Fiber-Max) Sodium (F208) Carbohydrates by calculation** (F215) Colorants (specify) Calcium (F209) Calories from Fat (F216) Iron (F210) Preservatives Sweeteners (specify) (specify) Complete Nutritional Analysis (includes all Parameters Above) (F201) Camera Ready Facts Panel (Complete Nutritional Analysis needed) (F218) Other (explain in Comments section): Omega Fatty Acids (specify) *Content per 100g, content per serving, % RDI (actual and rounded) and % DV(based ¹Contact Lab prior to Sample Submittal for on 2000 kcal) provided where applicable. Serving size and ingredient declaration may be required ** Carbohydrate and Calorie content require analysis of: Protein, Moisture, Fat and Ash Pricing and Availability *Please sign and Submit the attached Sub-Analysis Agreement with your Samples* Sample # Sample Description Ingredient Declaration Serving Size

Client Sample #’s: - Total # of Samples:

Relinquished (Client): Date: Time: Date: Received (Lab): Time: Relinquished: Date: Time: Received (Lab): Date: Time: **Comments:

Controlled Document --- Food PhysicalCOC – R3– 2/23/2011 Page 1 of ____ pages Food Chemistry Chain of Custody EMSL ANALYTICAL, INC. 200 ROUTE 130 NORTH EMSL ORDER ID (Lab Use Only): CINNAMINSON, NJ 08077 PHONE: (800) 220-3675 FAX: (856) 786-0392

Additional Pages of the Chain of Custody are only necessary if needed for additional sample information Sample # Sample Description Ingredient Declaration Serving Size

Comments/Special Instructions:

Controlled Document --- Food PhysicalCOC – R3– 2/23/2011 Page ______of ______pages

EMSL ANALYTICAL, INC. 200 ROUTE 130 NORTH CINNAMINSON, NJ 08077 SUB-ANALYSIS AGREEMENT PHONE: (800) 220-3675 FAX: (856) 786-0392

Depending upon logistics, methodology or availability, it may be necessary for the samples you submitted to be analyzed at a different laboratory. Should that contingency occur, the undersigned agrees to the following terms:

1. In the event that the EMSL Analytical, Inc. facility where the samples were initially received is unable to perform the testing specified on the COC, EMSL Analytical, Inc. will transfer the samples to a laboratory (EMSL or other) that is currently approved for the parameter being tested.

2. EMSL Analytical, Inc. will observe strict chain-of-custody procedures when sending and receiving samples.

3. The analyzing laboratory will follow accepted, certified methods for the analysis, and will report the results to EMSL Analytical, Inc. in writing, using accepted formats.

4. EMSL Analytical, Inc. will, insofar as possible, meet all promised turnaround times, however, we cannot be held responsible for delays due to trans- shipment or other problems outside of our control.

5. Customer agrees to these terms as a condition of submitting these samples to EMSL Analytical, Inc.

Name ______Date______

Company/Title ______

Please sign upon receipt and submit with samples or fax to: Attn: Food Chemistry Laboratory @ (856) 786-0392

Controlled Document --- Food PhysicalCOC – R3– 2/23/2011

EMSL ANALYTICAL, INC. 200 ROUTE 130 NORTH PACKAGING AND SHIPPING CINNAMINSON, NJ 08077 PHONE: (800) 220-3675 GUIDELINES FAX: (856) 786-0392

When shipping samples to the laboratory for analysis please use the following guidelines:

 Submit adequate amount of sample.  Contact your EMSL Sales Representative or analyzing laboratory for specifics. Insufficient sample amount will lead to delays in analysis.

 Submit samples in sealed packaging or containers  Package in such a way as to prevent samples from leaking, spilling, breaking, or otherwise compromise the integrity of the samples

 Include a completed Chain of Custody with samples  In a separate plastic bag, to ensure it doesn’t get wet or damaged

 Ship samples in a cooler, with ice packs, for overnight delivery to the analyzing laboratory  Do not use ice cubes  Do not use dry ice, unless specifically instructed

 Identify sample type on the outside of the package simply by clearly noting “FOOD SAMPLE”  This will ensure that the sample gets to the proper department upon receipt, and notify receiving staff to institute proper food sample handling procedures.

Improper packaging during shipment may compromise the quality and integrity of laboratory generated data. EMSL Analytical, Inc reserves the right to reject samples if sample integrity or staff safety is in question.

Controlled Document --- Food PhysicalCOC – R3– 2/23/2011