SAMPLE TESTING APPLICATION FORM

Order No. OD.16050721 Quotation No. -

Customer PT. Monde Mahkota Biskuit Contact Person Mrs Yuli Daefani

Address Jl. Tekno Raya Blok A7 Kawasan Email yuli.daefani@mondebiscuit.com

Industri Jababeka III, Kelurahan
PasirGombong,
Cikarang Utara - Bekasi Phone 021-29569741, 021-871728 ,
3806966
Indonesia Fax 021-29569744

Sample Code SC.160502588 Sample Name Krekers Mailkist Rasa Keju

(Malkist Crackers Cheese)
Volume / 2 Description Metalized Plastic
Quantity
Priority Urgent Received Date 2016-05-27 COA Release 2016-06-06
Date
No Parameters Method
1 Energy By calculation
2 Energy from fat By calculation
3 Moisture SNI 01-2891-1992 (5.1)
4 Ash SNI 01-2891-1992 Butir 6.1
5 Fat SNI 01-2891-1992 (8.2)
6 Protein (N x 6.25) SNI 01-2891-1992 Butir 7.1
7 Carbohydrate by difference
8 Dietary Fiber AOAC 985.29 17th ed. 2000 (Enzymatic)
9 Sodium (Na) AOAC 985.35 17th ed. 2000
10 Total Sugar SNI 01-2892-1992 Butir 3.1
11 Lead (Pb) SNI 01-2896-1998 Butir 5
12 Cadmium (Cd) AOAC 999.11 17th ed. 2000
13 Tin (Sn) SNI 01-2896-1998 Butir 5
14 Mercury (Hg) SNI 01-2896-1998 Butir 6
15 Arsenic (As) SNI 01-4866-1998 Butir 6

PT TÜV NORD Indonesia

Head Office
Laboratory & LSPro Department Surabaya Branch Office
Perkantoran Hijau Arkadia, Tower F 7th
Jl Science Timur 1 Block B3-F1, Intiland Tower 11th Floor, Suite 1 E,
Floor, Suite 706 Jl TB Simatupang Kav
Kawasan Industri Jababeka V Cibatu Jalan Panglima Sudirman 101 - 103,
88, Jakarta Selatan
Cikarang - Bekasi 17530 Surabaya 60271
Telepon +62 21 78837338
Telepon +62 21 29574720 Telepon +62 31 5344454
Fax +62 21 78837336
Fax +62 21 29574721 Fax +62 31 5344482
Email indonesia@tuv-nord.com
 16 Saturated Fat (SAFA) AOCS 4th ed. Ce 2-66, 1994
17 TFA (Trans Fatty Acid) AOAC 985.21 (GC)
18 Total Plate Count at 30oC for 72 H SNI 01-2897-1992 Butir 1.1
19 Coliform SNI 01-2897-1992 (2.1) MPN-3
20 Escherichia coli SNI 01-2897-1992 Butir 3.1
21 Salmonella sp. SNI 01-2897-1992 (4)
22 Staphylococcus aureus BAM 2001 chapter 12 (spread plate)
23 Mold Compendium 3rd edition, Chap. 16.52, th. 1992
24 Yeast Compendium 3rd edition, Chap. 16.52, th. 1992
25 Bacillus cereus ISO_7932;2004(E); MU-4/21 (isolation)

Remarks

Jenis Sample Snack

Submitted by Yuli
Received by Ghuntur Angriawan
Reviewed by Ni'matulloh

Customer Approval:
_______________________________________________________________________

PT TÜV NORD Indonesia

Head Office
Laboratory & LSPro Department Surabaya Branch Office
Perkantoran Hijau Arkadia, Tower F 7th
Jl Science Timur 1 Block B3-F1, Intiland Tower 11th Floor, Suite 1 E,
Floor, Suite 706 Jl TB Simatupang Kav
Kawasan Industri Jababeka V Cibatu Jalan Panglima Sudirman 101 - 103,
88, Jakarta Selatan
Cikarang - Bekasi 17530 Surabaya 60271
Telepon +62 21 78837338
Telepon +62 21 29574720 Telepon +62 31 5344454
Fax +62 21 78837336
Fax +62 21 29574721 Fax +62 31 5344482
Email indonesia@tuv-nord.com
 Date 27 May 2016

ORDER DETAIL Order No.

OD.16050721
021-29569741, 021-871728 ,
To Mrs Yuli Daefani Phone
3806966
Company PT. Monde Mahkota Biskuit Fax 021-29569744
Address Jl. Tekno Raya Blok A7 Kawasan Mobile Phone
Industri Jababeka III, Kelurahan
PasirGombong, Email Address yuli.daefani@mondebiscuit.com

No SERVICES METHOD PRICE DISC% PC% / TOTAL

QTY
Krekers Mailkist Rasa Keju (Malkist Crackers Cheese) Priority Urgent
1 Energy By calculation 0 0 50 0
2 Energy from fat By calculation 0 0 50 0
3 Moisture SNI 01-2891-1992 (5.1) 0 0 50 0
4 Ash SNI 01-2891-1992 Butir 0 0 50 0
6.1
5 Fat SNI 01-2891-1992 (8.2) 0 0 50 0
6 Protein (N x 6.25) SNI 01-2891-1992 Butir 0 0 50 0
7.1
7 Carbohydrate by difference 350,000 0 50 525,000
8 Dietary Fiber AOAC 985.29 17th ed. 400,000 0 50 600,000
2000 (Enzymatic)
9 Sodium (Na) AOAC 985.35 17th ed. 130,000 0 50 195,000
2000
10 Total Sugar SNI 01-2892-1992 Butir 100,000 0 50 150,000
3.1
11 Lead (Pb) SNI 01-2896-1998 Butir 5 110,000 0 50 165,000

12 Cadmium (Cd) AOAC 999.11 17th ed. 110,000 0 50 165,000

2000
13 Tin (Sn) SNI 01-2896-1998 Butir 5 110,000 0 50 165,000

14 Mercury (Hg) SNI 01-2896-1998 Butir 6 110,000 0 50 165,000

PT TÜV NORD Indonesia

Head Office
Laboratory & LSPro Department Surabaya Branch Office
Perkantoran Hijau Arkadia, Tower F 7th
Jl Science Timur 1 Block B3-F1, Intiland Tower 11th Floor, Suite 1 E,
Floor, Suite 706 Jl TB Simatupang Kav
Kawasan Industri Jababeka V Cibatu Jalan Panglima Sudirman 101 - 103,
88, Jakarta Selatan
Cikarang - Bekasi 17530 Surabaya 60271
Telepon +62 21 78837338
Telepon +62 21 29574720 Telepon +62 31 5344454
Fax +62 21 78837336
Fax +62 21 29574721 Fax +62 31 5344482
Email indonesia@tuv-nord.com
 Date 27 May 2016

ORDER DETAIL Order No.

OD.16050721
15 Arsenic (As) SNI 01-4866-1998 Butir 6 110,000 0 50 165,000

16 Saturated Fat (SAFA) AOCS 4th ed. Ce 2-66, 400,000 0 50 600,000

1994
17 TFA (Trans Fatty Acid) AOAC 985.21 (GC) 400,000 0 50 600,000
18 Total Plate Count at 30oC SNI 01-2897-1992 Butir 100,000 0 50 150,000
for 72 H 1.1
19 Coliform SNI 01-2897-1992 (2.1) 100,000 0 50 150,000
MPN-3
20 Escherichia coli SNI 01-2897-1992 Butir 130,000 0 50 195,000
3.1
21 Salmonella sp. SNI 01-2897-1992 (4) 160,000 0 50 240,000
22 Staphylococcus aureus BAM 2001 chapter 12 250,000 0 50 375,000
(spread plate)
23 Mold & Yeast : 100,000 0 50 150,000
- Mold | Compendium 3rd edition, Chap. 16.52, th.
1992
- Yeast | Compendium 3rd edition, Chap. 16.52, th.
1992
24 Bacillus cereus ISO_7932;2004(E); 250,000 0 50 375,000
MU-4/21 (isolation)
Remarks : Sub Total 5,130,000
Jenis Sample Snack
VAT 513,000
Total 5,643,000

Term & Condition:

1. Turn arround Time :

Normal Analysis : 10 Working days
Urgent Analysis : 7 Working days
Very Urgent Analysis : 5 Working days
Subcontracted Analysis : 15 Working days
2. Sample(s) received after 2:00 PM will be considered on the following working day. Saturday, Sunday
and other public holiday are not working.
3. Minimun order per invoice is Rp. 200.000,-

PT TÜV NORD Indonesia

Head Office
Laboratory & LSPro Department Surabaya Branch Office
Perkantoran Hijau Arkadia, Tower F 7th
Jl Science Timur 1 Block B3-F1, Intiland Tower 11th Floor, Suite 1 E,
Floor, Suite 706 Jl TB Simatupang Kav
Kawasan Industri Jababeka V Cibatu Jalan Panglima Sudirman 101 - 103,
88, Jakarta Selatan
Cikarang - Bekasi 17530 Surabaya 60271
Telepon +62 21 78837338
Telepon +62 21 29574720 Telepon +62 31 5344454
Fax +62 21 78837336
Fax +62 21 29574721 Fax +62 31 5344482
Email indonesia@tuv-nord.com
 Date 27 May 2016

ORDER DETAIL Order No.

OD.16050721
4. The payment should be transferred to:
PT. TUV NORD Indonesia
Bank HSBC World Trade Center
A/C No. 050-074269-001
5. The test report will be delivered when payment has been setled

PT TÜV NORD Indonesia

Head Office
Laboratory & LSPro Department Surabaya Branch Office
Perkantoran Hijau Arkadia, Tower F 7th
Jl Science Timur 1 Block B3-F1, Intiland Tower 11th Floor, Suite 1 E,
Floor, Suite 706 Jl TB Simatupang Kav
Kawasan Industri Jababeka V Cibatu Jalan Panglima Sudirman 101 - 103,
88, Jakarta Selatan
Cikarang - Bekasi 17530 Surabaya 60271
Telepon +62 21 78837338
Telepon +62 21 29574720 Telepon +62 31 5344454
Fax +62 21 78837336
Fax +62 21 29574721 Fax +62 31 5344482
Email indonesia@tuv-nord.com