中矿泉水检测申请表-美国实验室1.docVIP

(Please complete a questionnaire for each plant location.) Company Name:Yanbian tianchi mineral water beverage co.ltd Company Address:hong feng village er daotown antu county Jilin province Contact Name: Company Shipping Address: Company Billing Address: Phone Number: Ext: Fax Number: Email: How did you hear about NTL? In what MONTH do you submit samples for analysis: Are you an IBWA Member: YES NO Are you a member of any other bottled water/industry association? YES NO If yes, which one(s): Are you a member of a buying association/purchasing group? YES NO If yes, please list: Brand Names: Size of Product(s): 产品的尺寸 16 oz 20 oz. 0.5 L 1.0 L 1.5 L 1.0 Gal 2.5 Gal. 3 Gal. 5Gal. Other:0.6L 2L Types of Beverage(s): 饮料的类型 bottled water carbonated beverage flavored beverage bulk water Other:_______________________ Types of Bottled Water Product(s): 瓶装水产品的类型 distilled purified √spring RO mineral drinking Fluoridated Other: _______________________ How many production lines do you have? _你有多少条生产线__1条_____________ Do you test each line? √YES NO 每条线都会测试吗？ Do you sell any of your products as lab reagent water? √YES NO 你的产品有作为实验室用水吗？》？ Do you bottle at the source? 瓶装吗？ √YES NO Is your product NSF Certified? 是否有NSF认证？ YES √NO 如果超过两个资源，请单独分来来提供。 Sources: (If more than two sources, provide information on a separate sheet.) Source Name:奶头泉矿泉水City: 吉林省安图县二道镇红丰村State:中华人民共和国 Source Type: Spring ( Borehole ( Municipal ( Well ( SurfaceWater ( 源泉类型 Other自涌泉 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Source Name:______________________ City: ___________________ State:_____ Source Type: Spring ( Borehole ( Municipal ( Well ( Surface Water ( Other __________________