1-2,;+:IKIXEFPI*VMIH6MGI 4EKI SJ 463(9'8()7'6-48-32 3YV[LSPIKVEMRZIKIXEFPIJVMIHVMGILEWFVS[RVMGIGEVVSXWKVIIRTIEWGSVRERHXVEHMXMSREP %WMERWIEWSRMRKW 6MGIWXE]WQSMWXPSRKIVERHHSIWRSXKIXWXMGO]SVGPYQT] 1E\MQM^ISZIRWTEGIEWSYVPFTEGOWM^IJMPPWSRIJYPPWLIIXTER 2STVIWIVZEXMZIWSV2S17+EHHIH 1)29%440-'%8-327 +VIEXMXIQXSWIVZIEWEWMHIXSER%WMERWX]PIIRXVÍI 46)4-27869'8-327 -2+6)(-)287 4VILIEXGSRZIGXMSRSZIRXS*7TVE]JYPPWM^IWXIEQXEFPITER[MXLZIKIXEFPIWTVE]3TIRFEKERHTPEGI &VS[R6MGI'EVVSXW+VIIR4IEW'SVR7IEWSRMRK 1EPXSHI\XVMR7S] ZIKIXEFPIJVMIHVMGIMRTERWTVIEHIZIRP]ERHGSZIVXLITERXMKLXP][MXLJSMP'SSOJSVQMRYXIWSVYRXMP 7EYGI4S[HIV?7S]7EYGI_;LIEX7S]FIERW7EPXa1EPXSHI\XVMR XIQTIVEXYVIVIEGLIW*SVEFSZI,EPJ[E]XLVSYKLXLIGSSOG]GPISTIRJSMPGEVIJYPP]ERHWXMVZIKIXEFPIJVMIH 7EPXA7EPX+EVPMG4S[HIV3RMSR4S[HIV'EVEQIP'SPSV:MRIKEV VMGIVITPEGIJSMPERHGSRXMRYIXSGSQTPIXIGSSOMRK6IQSZIJVSQSZIRYRGSZIVERHQM\FIJSVIWIVZMRK'SSOMRK 4S[HIV?1EPXSHI\XVMR;LMXI(MWXMPPIH:MRIKEV1SHMJMIH*SSH7XEVGLA IUYMTQIRXQE]ZEV]%HNYWXGSSOMRKXMQIETTVSTVMEXIP] 0IWW8LER 3J7TMGI7YKEV=IEWX)\XVEGX*VYGXSWI1SHMJMIH *SSH7XEVGL0EGXMG%GMH8SEWXIH7IWEQI3MP7MPMGSR(MS\MHI ?%RXM'EOMRKA7S]FIER3MP 'SSOMRK1IXLSH 8IQT 8MQI -RWXVYGXMSRW 'SRZIGXMSR3ZIR * 1-298)7 4VITEVIJVSQJVS^IRWXEXI 7,-44-2+-2*37,)0*0-*) %00)6+)27 7,-44-2+-2*3 'SRXEMRW +8-2 'EWI ;LIEXSVMXW(IVMZEXMZIW7S]SVMXW +VSWW;IMKLX (IVMZEXMZIW 2IX;IMKLX )EGL;IMKLX 'YFI (MQIRWMSRW 0\;\, \\ 'EWIW4EPPIX 8MI ,MKL 7,)0*0-*) -RJSVQEXMSRGSRXEMRIHMRXLMWHSGYQIRXMWFIPMIZIHXSFIEGGYVEXIERHSJJIVIHMRKSSHJEMXLJSVXLIFIRIJMXSJXLIGYWXSQIV 2YXVMXMSRHEXEMWGEPGYPEXIHERHSJJIVIHJSVMRJSVQEXMSRTYVTSWIWWSQIZEVMEXMSRGERSGGYVHITIRHMRKSRWIZIVEPJEGXSVW8LMW HSGYQIRXQE]GSRXEMRTVSTVMIXEV]GSRJMHIRXMEPXVEHIWIGVIXSVTVMZMPIKIHMRJSVQEXMSR%R]YREYXLSVM^IHVIZMI[YWIHMWGPSWYVI SVHMWXVMFYXMSRMWTVSLMFMXIHERHQE]FIEZMSPEXMSRSJPE[ 'ST]VMKLX7GL[ER W*SSH7IVZMGI-RG%PP6MKLXW6IWIVZIH ;IWX'SPPIKI(VMZI`1EVWLEPP12`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`1EVWLEPP12` /EVIR;MPHIV6(14,0( MRJS$WGL[ERWJWGSQ 7V(MVIGXSV7GMIRXMJMG 6IKYPEXSV]%JJEMVW 0EWX9THEXI(EXI4VMRXIHSR Product Formulation Statement For Documenting in School Meals Product Code: 69074 Product Name: Minh® Vegetable Fried Brown Rice Serving Size: 1 Serving 5.90 oz 167g GRAINS: Does the product meet the Whole Grain Rich Criteria? Yes Does the product contain non-creditable grains: Indicate to which Exhibit A Group (A-I) the product belongs: Group H Description of Creditable Grain Ingredient Grams of Creditable Grain Ingredient per Gram Standard of Creditable Grain per oz Equivalent (B) Creditable Amount Portion (A) 16g or 28g (A/B) Rice (Brown, Long Grain, Regular, Dry) 56.45g 28g 2.01 oz Total Creditable Amount I certify that the above information is true and correctand that a 5.90 ounce portion of this product (ready forserving) provides 2.00 oz equivalent Grains. I further certify that non-creditable grains are notabove 0.24 oz equivalent per portions. Products with more than0.24 oz equivalent or 3.99 grams for Groups A-G or 6.99 grams for Group H of non-creditable grains may not credit towards the grain requirements for school meals. VEGETABL ES / FRUITS: Description of Creditable Ingredient per Vegetable Ounces per Raw Portion of Creditable Multiply FBG Yield/Pur chase Unit per Creditable Amount Food Buying Guide (FBG) Subgroup Ingredient Pound Carrots (Frozen, Ready to Cook, Diced per Red/Orange 0.86 oz X 9.87/16 oz 0.53 Labeling for Products) Green Peas (Frozen, Shelled per Child Starchy 0.42 oz X 9.59/16 oz 0.25 Corn (Whole Kernel, Frozen per Child Starchy 0.39 oz X 11.00/16 oz 0.26 Total Creditable Amount 1.04 I certify the aboveinformationis true and correct and that a 5.90 ounce serving of the above product (ready forserving) provides 1/8 cup(s) of Red/Orange Vegetables and 1/8 cup(s) Starchy Vegetables. MEAT / MEAT ALTERNATES (M/MA): Description of Creditable Ingredient per Ounces per Raw Portion of Creditable Ingredient Multiply Source Label Crediting or FBG Creditable Amount Food Buying Guide (FBG) Yield/Pur chase Unit per Pound Total Creditable M/MA Amount 0.00 ALTERNATE PROTEIN PRODUCT (APP): Description of APP Manufactures Name and Code Number Ounces Dry APP Per Portion Multiply % of Protein As-Is Divide Creditable Amount APP Total Creditable APP Amount 0.00 Total Creditable Amount of M/MA & APP 0.00 I certify that the above information is true and correctand that a 5.90 ounceserving of the above product (ready for serving) provides 0.00 ounces of equivalent meat/meatalternate when preparedaccording to directions. I furthercertify thatany APP usedin the product conforms to the Food 12-15 Karen Wilder, RD, MPH, LD Sr Director,Scientific & Regulatory Affairs 1.800.544.6855 Enriching the quality of lives through our food solutions. t h h f d.