Document 4aZ8O9Zye45pbBryXxEb0bd81
TAYLOR*
Taylor Company
750 North Blackhawk Boulevard Rockton, Illinois 61072-2199
March 11, 1993
Phone: (815) 624-8333 Telex: 257329 TAYFREEZ
6871502TAYLO Fax: (815) 624-8000 Cable: TAYFREEZ
Mr. Doug Wetzig B F Goodrich 6100 Oak Tree Blvd Cleveland OH 44131
Subject:
NSF Material Formulation Confidential Report NSF Document Control Code FD03693-001
Dear Mr. Wetzig:
Enclosed is an NSF Material Formulation Confidential Report form, for the above material, requiring the completion of Parts V and VI. NSF requires this information before granting certification of this material for use in a food contact application.
Please note that each ingredient must be identified in Section V, with appropriate reference to the U.S. Code of Federal Regulations (21 CFR), no abbreviations permitted. We are invoiced S65.0Q for incomplete formulation reports furnished to NSF. To avoid unnecessary charges, please complete Parts V and VI properly. Send the completed form, using the blue envelope, directly to:
Toxicology Services NSF International PO Box 130140 Ann Arbor, Michigan 48113-0140
Your cooperation in handling this request is appreciated.
Very truly yours,
:-Q>
Norman L. Beck Senior Project Engineer
cc: Steve Schwitters
mfcrgeon.303
BFG16H7
International Office: Taylor Company S.r.l. Viale Shakespeare, 47 00144 Roma, Italy Phone: 39-6-591-6561
39-6-541-3809 Telex: 611650 Fax: 39-6-592-4379
21707005
COMPOSITION OF FORMULATION AND PERTINENT DATA
Smboii of mo OS. Code of "ederai: flaquutea (21 Ct-Ki ' unoer wtwcft accepted.
PLEASE PROVIDE SIGNATURE/CERTIFICATION ON REVERSE SIDE.
AvailaOla fium the Suoenntenaant cf Documents, u. S. Government. Printing Office. Wasmngton. D.C. 20402 (202-78 or your.tocal U. S. Government Printing Office outlet.
Title 21 '(food and Orugsl. Pam 1-99:
General information and color additives (direct).
.,h.UBioEI,'iF0*,P *n0 Orugsl. Parts 170-199: Oirect and indirect lood additives, including ingredients for use in food
NSF international MATERIAL FORMULATION CONFIDENTIAL REPORT
Document Control Code FD03693-001
Company Number 45800
Regional Office 02
R T f^sge pae ^3^08/93
Regional Representative KBS * * * DO
N jiTD D. IU
LICATE
Standard Number 6/18 CBI Code ___________________
***
i. program participant
TAYLOR CQMPAN'/-ROCKTON iL
TAYLOR COMPANY
MR. NORMAN BECK
ROCKTON. IL
61072
Plant At: ROCKTON, IL
61072
II. MODEL(S) Equipment Model Number(a) All Models Description of Equipment Soft serve, shake,
slush .& batch freezers
III. PART(S)
Description of Bnrtts) Spinney
Part Number(s) 169i-BLK, 201J3-BLK
..
Fabricated by pyratM-d Plastics
Surface Area of-partCs3 (eq. im) 8
Surface is
|X1 Smooth
Part is [x] Food zone, pood Contact Temperature (Range) Par"t(a) Exposed to 10-40 Type of Food/Water/Etc .:;s Dairy;og.SL,Al
'P
Contact Area (sq, in.) 8 '
IV. SUPPLIER Basic MateriaI:SUpplier Material Type Complete Fornrnl&trion Id
BP Goodrich PVC/Natural aeon BGiSS-0027
rr Natural ; i ] Precolore^l
i i See Form
V. COMPOSITIOWSOF FORMULATlON::AND PERTINENT DATA - USE REVERSE SID*. To Be Completed By Basic Material/Pigment Supplier.
VI.
CERTIFICATION It is herein certified that this material is intended for the specific end use application. It is further certified that the Information provided is accurate and complete and, in the case of materials intended for food zone application the material meets the requirements of the Federal Food, Drug, and Cosmetic Act as amended.
Company Signature Title AddresB Telephone Date
BASIC MATERIAL SUPPLIER The Geon Company/BFGoodrich
, rtf AO------i.
( l itrjLn i.J?r
TSg&ii/ay Coor(jt|fI ttor
c)rv
biUU'Tjak TreeMUvd.. Cleveland, OH 4-4131
216/447-7758
fST 2I6/44)-6262
March 23. 1993
Seal in the BLUE envelope provided, insert in an outer envelope and MAIL TO:
Toxicology Services NSF International PO Box 130140
Ann Arbor, MI 48113-0140
Page (1)
5
o .s
d
NSF International MATERIAL FORMULATION CONFIDENTIAL REPORT
P-'?/7
Document -rional ,ional
Control Code FD03693-D01
Company Number 45800
office 02
Issue Date 04/02/93
Representative KBS
* * * DO
NOT
DUPLICATE
Standard Number 6/18 CBI Code 07669
I. PROGRAM PARTICIPANT
TAYLOR COMPANY
MR. NORMAN BECK
ROCKTON, IL
61072
Plant At: ROCKTON, IL
61072
II. MODEL(S) Equipment Model Number(s) All Models Description of Equipment Soft serve, shake,
slush & batch freezers
III. PART (S) lllflll!
:|g|
Description of Part(s) Spinne|p;t:;i
////:;:
Part Number(si 3,8961-BLK, 201L2-BLK
Fabricated by ^Pyramid Plastics
Surface Area of Part(S) (sq. In.) 8
Surface Area of Part is [X] smooth
Part is [X] Food Zone, Food contact
Temperature (Range) Parfefs) Exposed to 10-40 'F
Type of Food/Water/Etc. Dairy, Yog.SL,A1
. ' .............................. Contact Area (sq. In.) 8
iv. supplier
Basic Material Supplier
Material Type Complete Formulation Id
illlli
GEOS COMPANY/BF. GOODRICH
PVC Geon 88155-0027
[XI Natural
[ ] Precolored: { j See Form:: ? j..................... 1 %
V. FORMULATION*REVIEW NON-ACCEPTANCE.
W!
Me are unable to accept this component of your equipment because:
The formulation information provided by the supplier is not sufficient to permit complete review.
An appropriate section of the U.S. Code of Federal Regulations, Title 21 (Food and Drugs) is not cited for each Ingredient. Specific Title 21 citations are generally required for a food zone material. Additional information (le. extraction studies, toxicity data, etc.) to support the use of materials not covered by Title 21 of the U.S. Code of Federal Regulations was not provided.
Please resubmit on the enclosed form.
G WEAVER Toxicology Services
21707008
BFG16180
I
it it if if it if if if if if it if it if it it it if it it if it if if if if it if it ii it
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R 04/27/93 14:32:49
B
LAB REF: BASED ON APPLICATION -
:;pT ; 5697
DATE: 01/05/9 F LAG : NO CM PR
ISSUE:
806
PARTS
INGREDIENTS
SEQ L.OC PERCENT
1A0.00000 961000114 110 X 334 ' i 9.00000 942 711737 1 430 X 20 OFF GRADE:
941 71 i 73cr~230l OFF7-" GRADE
001 002
003
925 716634 CAMEL-CAL ST it) 943 O0I...O34 CA STEARAl E-FUSED
. 0 0 0 0 0 94 3 O 0 L 0 A 0 P A R A F FIN 1 6 5 F ft . P ,.
005 oo*
00 7
72.464 8.69* 1 ..449
7ft
14.493 1 .449
138.0000
TOTAL
100.000
SPECIFIC GRAVITY TYPE SAMPLE ISSUED
MARKETING APPROVAL
1 .4).
MISC CMNT: SEP ENTERPRISE PRODUCT MANAGEMENT
n4:
// : '
-
-
7 ynri7;-fcfaj
HARDNESS: D-SO COLOR : 2
, -?: r-:
7 7^ it*--' ' '
a, - -/ A Cl
7-9/. /-f /
.. /'
(SAX 5
/ f /. 7 f ; /'7>. 2 'OJI "7?
7 is;
. - 7 tt
21708001
BFG16181
C617D096 C617F096
CAS NO.
100-42-5 106-99-0 107-13-1 9003-18-3 14807-96-6
INVENTORY NO / CAS INQUIRY GEON PROD
INVENTORY NUMBER : 942 / 71 / 1737
CONCT PCT.
DESCRIPTION
000.0100 000.0005 000.0020 100.0000 007.0000
BENZENE, ETHENYL1,3-BUTADIENE 2-PROPENENITRILE NITRILE POLYMER TALC, AS /MG3H2(SI03)4/
USERID: N50CND1A PTERMID: PV120110
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C617D096 C617F096
CAS NO.
AR-CP-D PB-CP-D CRC-CP-D 1317-65-3 7439-92-1 7440-38-2
INVENTORY NO / CAS INQUIRY GEON PROD
USERID: N50CND1A PTERMID: PV120110
INVENTORY NUMBER : 925 / 71 / 0684
CONCT PCT.
DESCRIPTION
000.0001 000.0003 000.0001 099.0000 000.0003 000.0001
ARSENIC COMPOUNDS LEAD COMPOUNDS CHROMIUM (HEXAVALENT) LIMESTONE LEAD ARSENIC
COMPOUNDS
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21708003
BFG16183