OfficialUseOnly(FTS内部填写).doc

Official Use Only(FTS 内部填写) Sales(销售代表)： Sample Rec.(收样人)： Rec. Date(收样日期)： Auditer(审核人)： Applicant Name 申请单位名称: Address 申请单位地址: Invoice Name 发票单位名称: Applicant申请方 Other其他: Invoice Address 发票送递地址: Applicant申请方 Other其他: Report Address 报告送递地址: ApplicantInvoice Address同发票送递地址 Other其他: Contact 联络人: Tel 电话: E-mail 电邮: Mobile 手机: Fax 传真: Buyer 买家 Product Information Test Required 产品信息及测试需求: No. 序号 Product Name 产品名称 Lot No. 批号 Model / Style 型号／规格 Sample Disassemble Requirement 测试拆分要求 Country of Destination 目的国 Sample No.样品编号 (FTS 内部填写) Sample Disassembly requirement and code测试拆分要求及代号:(1) Homogeneous material that can be tested directly样品为均质材料, 直接测试; (2) Heterogeneous materials that need to be disassembled for test样品由多种材料组成, 按均质材料原则进行拆分并测试;(3) Only part of material units need to be tested. Please specify仅对其中部分材料进行测试, 请在上表中注明具体测试部位; (4) Mixed-mode testing整体混合测试; (5) Other special disassembly requirement其他特殊拆分要求: U.S. FDA Food Grade Plastic：21 CFR 170-189 美国食品级塑料测试 21 CFR 175.300 Resinous and Polymeric Coatings 树脂或聚合物涂层 21 CFR 176.170 Paper Paperboard 纸和卡纸 21 CFR 177.1210 Closures with Sealing gaskets 密封填塞物 21 CFR 177.1460 Melamine - Formaldehyde Resins (MF) 三聚氰胺-甲醛 21 CFR 177.1520 Olefin Polymers 烯烃聚合物 PE PP Copolymer PP Homopolymer 21 CFR 177.1580 Polycarbonate (PC) 聚碳酸脂 21 CFR 177.2600 Rubber 橡胶 21 CFR 177.2420 Polyester Resins, Crosslinked 交联聚脂树脂 21 CFR 177.2470 Polyoxymethylene Copolymer 聚甲醛共聚物 21 CFR 177.1640 Polystyrene (PS) 聚苯乙烯 21 CFR 181.32 22 Acrylonitrile Copolymers (ABS) 丙烯腈共聚物 Other material 其它材料: Germany LFGB 德国食品级塑料测试 Polyethylene (PE) 聚乙烯 Polypropylene (PP) 聚丙烯 Polyethylene terephthalate(PET) 聚对苯二甲酸乙二醇酯 Nylon 尼龙 Acrylonitrile butadiene styrene (ABS) 丙烯腈-丁二烯-苯乙烯 Other material 其它材料: China Food Grade Plastic 中国食品级塑料测试 GB9691-1988 Polyethylene resin (PE) 聚乙烯树脂 GB9687-1988 Polyethylene product (PE) 聚乙烯成型品 GB9693-1988 Polypropylene resin (PP