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[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,"MICRO ANALYSIS REQUEST FORM",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ship To: "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nestle Quality Assurance Center"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Shipping: 6625 Eiterman Rd, Dublin, OH  43016"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Telephone: 614-526-5200"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NQAC Contact"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NQAC Dublin Customer Service "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Primary Contact for Deviations"]
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[]
["SUPPLIER OR FACTORY NAME AND LOCATION",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NAME OF SUBMITTER:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NQAC Customer ID :",null,null,null,null,null,null,null,null,"of "]
["Fill in business name, address, phone and fax below:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Page"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DATE SUBMITTED/SHIPPED TO NQAC:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Client P.O. or Reference # : "]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"REPORT RECIPIENTS (Please include email if outside of Nestlé)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Project Description "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"3."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"  Please refer to the Nestle product specification to choose the weight requirement and testing needed from the drop down box/check box.      "]
["TELEPHONE:  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5."]
["FAX:  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"6."]
[null,"All samples for Microbiological testing are started within 24 hours of being received at NQAC unless otherwise advised."]
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["Please fill in Sample Description, SAP Lot, and (if desired) SAP Material ID as you would like for them to appear on the report."]
["NQAC NUMBER                                                              (for internal use only)",null,null,"Sample Type",null,"Sample Description (Product Name)",null,null,null,null,null,null,"SAP Lot or \nProduction Code",null,null,null,null,null,"Client Sample ID #","Pooled?","SAP Material ID #",null,null,null,"General Testing",null,null,null,null,null,null,null,null,null,null,null,null,"Pathogen Testing"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"APC",null,"EB",null,"Coliforms / E.Coli",null,null,null,"Mold / Yeast",null,null,null,"Staph (CPS)","Listeria","Salmonella",null,"Other"]
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["Special Instuctions "]
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["Note: Please enclose a copy of this form in the box with the shipment!"]
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["25g","25g","30°C",null,"Mold only",null,null,null,null,"Coliforms only"]
["100g","100g","37°C",null,"Yeast only",null,null,null,null,"E. Coli only"]
["125g","125g",null,null,"Both",null,null,null,null,"Both"]
["150g","250g"]
["250g","swab"]
["325g"]
["375g"]
["750g"]
["1500g"]
["swab"]
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[]
[null,null,"Petrifilm","Y","FP"]
[null,null,"Petrifilm x2","N","RM"]
[null,null,"Pour Plate ",null,"ENV"]
[null,null,"Pour Plate x2",null,"WIP"]
[null,null,"MPN"]