Document zoepx3Xvam2OrBQG62QLo9Qr6

BFGoodrich * The BFGoodrich Company Geon Vinyl Division 6100 Oak Tree Boulevard Cleveland, Ohio 44131 216-447-6000 /\/!/ SV36 / ( ` April 28, 1993 Grace Weaver Toxicology Services NSF International P.O. Box 130140 Ann Arbor, MI 48113-0140 Dear Ms. Weaver: Enclosed please find the confidential composition of Geon 86155-0027 which is being submitted in support of the Taylor Company's application. This formulation is Company confidential and therefore subject to the generic secrecy agreement signed by BFGoodrich and the National Sanitation International, October 24, 1979. If you have any questions, please contact me at (216) 4477831. Sincerely, THE BFGOODRICH COMPANY Regulatory and Data System Specialist 0428-1/jk Enclosure * The Geon Company effective 3/1/93 bcc: Doug Wetzig/Joe Kelley BFG16173 21707001 NSF International MATERIAL FORMULATION CONFIDENTIAL REPORT Document Control Code Regional Office 02 FD03693-001 Company Number 45800 Issue Date 04/02/93 RESUBMITTAL * DO NOT DUPLICATE Standard Number 6/18 CBI Code I. PROGRAM PARTICIPANT TAYLOR COMPANY Plant At: ROCKTON, MR. NORMAN BECK ROCKTON, IL 61072 ^ c i j'k II. MODEMS) Equipment Model Number(sjf,^ll f, M ,u Description of Equipment!'Sort1 serve, shake, slush & batch freezers IL 61072 III. Jr&RTtS) Description of part(s) Spinner .................. part Number(a) 1SS61-BLK, 20112-BLK Fabricated by pyramid Plastics Surface Area Of Part fa) (sq. in.) 8 Surface Area of Part is [X] Smooth part is [X] Pood Zone* Food Contact Temperature (Range) Partfs) Exposed to 10-40 *F Type of Food/Water/EtcJ. Dairy, Yog.SL,A1 Contact Area (sq. in.) 8 IV. SUPPLIER Basic Materia|||||ipplier Material Type Complete Formu&a||ion id GEON COMPANY/BP GOODRICH PVC Geon 6S155-0027 ti;:iii|Na turai|ip| i 3 Precolored; {, 4 See Forms, V. COMPOSITION OF FORMULATION AND PERTINENT DATA - US* REVERSE SIDE. To Be Completed By Basic Naterial/Pigmeftt 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 CoBmetic Act as amended. Comoanv Signature Title Address Telephone Date BASIC MATERIAL SUPPLIER Qfion Company/BIJ--Goodrich {'.mtslil., yl. \ i/jLttv RepuTat-.orv and Data System Specialist 61 CD flaV Tree Rlvd. ?lA//,/,7-7R71 FAX 216/447-6459 04/2s7<n__________________________________________________________________ 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 21707002 Page (1) BFG16174 1 V COMPOSITION OF FORMULATION AND PERTINENT DATA Chemical Description of Ingredient (Do NOT Use Trade Names! Please verify the material type/color and formulation identification referenced m Sechon IV on the reverse. Bi'gthylhe.xyl Fhthalate PVC Resin Parts by Weight Supplier Section of the U.S. Code of Federal Regulations (21 CFR)* under which accepted.__________ 25.78% 66.11% BASF; Aristica Chemical; Eastern Chem. 175.105/300/320/380/390; 176.180/170/210'; 177.1200/1210/1400/1460/2600; 178.3910; 181.27 BFG/Geon Co. Prior Sanction Epoxidized Linseed Oil 6.61% American Chem. 178.3740; 181.27 Calcium Zinc Stabilizer 1.32% Synthetic Pdts 178.2010; 181.29; 181.27 C.X. Pigment Violet 15 0.02% Whittaker, Clark & Daniels : 178. 3297 Blue Dispersion containing: Phthalocyanine Blue fc.I. 74160) Epoxidized Lindseed Oil PVC Resin 0.01% Americlient ':s%. 181.27; 178.3740; 178.3297 Stearic Acid 0.13% Henkel/ Quantum GRAS (Indirect contact) e o o t-jz jz PLEASE PROVIDE SIGNATURE/CERTIFICATION ON REVERSE SIDE. Available Irom the Superimenaent of Document. U. S. Government. Printing Office. Washington. D.C. 20402 (202-783-3238) or your local U. S. Government Priming Office outlet. Title 21 (Food and Drugs). Parts 1-99: General information and color additives (direct). 3:Itll:;' -^ (F8 and Drugs). Parts 170-199: Direct and indirect lood additives, including ingredients lor use in food contact '"'i materials. (2) BFG16175 C103D326 C103F326 SEON PROD BFGOODRICH BEON VINYL DIVISION RECIPE INQUIRY USERID: N50JCK3A PTERMIB: PV120066 PRODUCT NBR: 86155 OOD 0027 86155TRNP0027 LOC: 12 DEPT: 5678 ISSUE: 003 SBC: 1311 EFFECTIVE DATE: 930215 INTERMEDIATE RM NBR: TOTAL LBS RM: 151.255000 LBS PRODUCT: 151.255000 RECIPE TYPE: 1 PAGE 1 SEQ RAW MATL 001 961- 000584 002 931- 00P075 DESCRIPTION QUANTITYLC PERCENT COMMENTS 110 X 429 100.000000 66.1135 OK DIOCTYL PHTHALATp 39.000000 25.7843 QK //?-&/-/ 003 935- 00P057 004 915- 00S079 005 921- 00B273 EPOXOL 9-5 SYNPRON 221 VIOLET 5012 (RS 10.000000 2.000000 0.035000 6.6114 OK 1.3223 0 /< 0.0231 \ 006 923- 00B327 8-327 BLUE DISP 0.020000 0.0132 9, 007 943- 00L002 STEARIC ACID 0.200000 0.1322 0{C OF BFG16H6 NEXT RESPONSE: DC900016 RECIPE INQUIRY OK NEXT KEY: PF5-PROP PF6-RMKS PF9-SAFE PF10-INST 9 , fYd />: I'J. di-J Xkl) tt&J- /i CA-m.-LitA. b(.llklo 'iS.lftfv 75'. /OK') /7 f * <ica _______ / ~7f 37vc? ____________- >7r, zc/oy&.W /&,-2'7 W&U,yC&jiX j>u., /b^-orrA, ` V-; ' WJvH v" 'iZ* --v >4- y 6, ----- ns.n&j ^zl?` l'-P" 5mu. i 'i J