Form LSAD100F7.12 "Dairy Product Requisition" - Nova Scotia, Canada

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Download Form LSAD100F7.12 "Dairy Product Requisition" - Nova Scotia, Canada

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DAIRY PRODUCT REQUISITION
NSDA Animal & Plant Laboratory – Harlow Building
Name:
Address:
Postal Code:
Telephone:
Fax:
Email:
Report Copied to (name and email):
COMPLETE ONLY THE SECTIONS OF THIS FORM THAT RELATE TO THE SAMPLE TYPES BEING SUBMITTED
NOTE: Fluid milk and processed byproduct samples must be received between 0.0 – 4.4°C
Date Received:
FOOD SAFETY – RAW MILK OFFICIAL TESTING
Order ID:
☐ Cow ☐ Goat ☐ Other _______________________
Milk Type:
Sample ID
Test(s) Requested (✓ all required)
Date Collected
-001
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-002
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-003
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-004
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-005
Date Received:
RAW MILK RETEST
(NSDA Dairy Inspector)
Order ID:
Sample ID
Test(s) Requested (✓ all required)
Date Collected
-001
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-002
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-003
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-004
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-005
Date Received:
PROCESSED MILK
Order ID:
☐ Cow ☐ Goat ☐ Other _______________________
Milk Type:
Sample ID
Test(s) Requested (✓ all required)
Date Processed
-001
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-002
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-003
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-004
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-005
*NOTE: Fat testing performed at outside accredited laboratory
Other testing available upon request: pH
LSAD100F7.12
Page 1 of 2
DAIRY PRODUCT REQUISITION
NSDA Animal & Plant Laboratory – Harlow Building
Name:
Address:
Postal Code:
Telephone:
Fax:
Email:
Report Copied to (name and email):
COMPLETE ONLY THE SECTIONS OF THIS FORM THAT RELATE TO THE SAMPLE TYPES BEING SUBMITTED
NOTE: Fluid milk and processed byproduct samples must be received between 0.0 – 4.4°C
Date Received:
FOOD SAFETY – RAW MILK OFFICIAL TESTING
Order ID:
☐ Cow ☐ Goat ☐ Other _______________________
Milk Type:
Sample ID
Test(s) Requested (✓ all required)
Date Collected
-001
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-002
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-003
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-004
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point ☐ Compositional (Referred out)
-005
Date Received:
RAW MILK RETEST
(NSDA Dairy Inspector)
Order ID:
Sample ID
Test(s) Requested (✓ all required)
Date Collected
-001
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-002
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-003
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-004
☐ IBC ☐ Lab Pasteurization ☐ Freezing Point
-005
Date Received:
PROCESSED MILK
Order ID:
☐ Cow ☐ Goat ☐ Other _______________________
Milk Type:
Sample ID
Test(s) Requested (✓ all required)
Date Processed
-001
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-002
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-003
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-004
☐ SPC ☐ SPC (7-day) ☐ SPC (14-day) ☐ Coliform/E.coli ☐ Added Water ☐ Fat*
-005
*NOTE: Fat testing performed at outside accredited laboratory
Other testing available upon request: pH
LSAD100F7.12
Page 1 of 2
Date Received:
PROCESSED BYPRODUCTS
Order ID:
☐ Ice cream ☐ Yogurt ☐ Kefir ☐ Other _________________________
Finished Product:
☐ Cow ☐ Goat ☐ Other _______________________
Milk Type:
Sample ID
Test(s) Requested (✓ all required)
Date Processed
-001
☐ SPC (ice cream only) ☐ Coliform/E.coli
☐ SPC (ice cream only) ☐ Coliform/E.coli
-002
☐ SPC (ice cream only) ☐ Coliform/E.coli
-003
☐ SPC (ice cream only) ☐ Coliform/E.coli
-004
☐ SPC (ice cream only) ☐ Coliform/E.coli
-005
Other testing available upon request: pH
Date Received:
MILK POWDER
Order ID:
☐ Skim ☐ Whey ☐ Buttermilk ☐ Other _________________________
Powder Type:
Sample ID
Test(s) Requested (✓ all required)
Date Collected
-001
☐ SPC ☐ Coliform/E.coli
☐ SPC ☐ Coliform/E.coli
-002
☐ SPC ☐ Coliform/E.coli
-003
☐ SPC ☐ Coliform/E.coli
-004
☐ SPC ☐ Coliform/E.coli
-005
Nova Scotia Department of Agriculture
Animal and Plant Laboratory
176 College Road, Truro NS B2N 2P3
Phone: 902-893-4683
Fax: 902-893-4193
www.novascotia.ca/agriculture-labs
LSAD100F7.12
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