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["中華兩岸優良工商經貿發展協會專用申請書"]
["電話:台北：02-22993279轉 尤小姐/6611 薛小姐/6774"]
["申請廠商","廠商名稱:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「報告抬頭」同申請廠商",null,null,null,null,null,null,null,null,"「報告抬頭」不同於申請廠商請列出:"]
[null,"廠商地址:"]
[null,"報告聯絡人:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「報告抬頭地址」同於申請廠商",null,null,null,null,null,null,null,null,"「報告抬頭地址」不同於申請廠商請列出:"]
[null,"報告聯絡電話:"]
[null,"※以上粗框內資訊均會呈現於報告中。"]
[null,"統一編號:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail:"]
[]
[null,"手機號碼:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話:",null,null,null,null,null,null,"Ext:",null,null,"傳真:"]
["發票廠商",null,"同申請廠商(勾選此欄以下免填)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"若與申請廠商不同請填寫以下資料，並填寫”付款切結書”。"]
[null,"廠商名稱:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地址:"]
[null,"統一編號:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話:",null,null,null,null,null,null,"Ext:",null,null,"傳真:"]
[null,"聯絡人:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail:"]
[null,"郵寄報告&發票若不同於申請廠商地址請另列:"]
["送測產品資訊","1.產品名稱：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送檢產品需拍照並紀錄狀態呈現於報告上，以下資訊請詳實填寫:",null,null,null,null,null,null,"由SGS填寫收樣時樣品狀態:"]
[null,"2.產品型號：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"樣品保存方式:",null,null,null,null,"冷凍",null,null,null,null,"冷凍"]
[null,"3.產品批號：",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,"冷藏",null,null,null,null,"冷藏"]
[null,"4.製造日期(年/月/日):    ",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,"常溫",null,null,null,null,"常溫"]
[null,"5.有效日期(年/月/日):",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"產品狀態與數量:"]
[null,"6.生產或供應廠商： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市售完整包裝",null,null,"數量:",null,null,"件"]
[null,"7.原產地/國："]
[null,"8.其他須在報告上顯示之資料(SGS保留審核與修正之權利)：    ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"散裝 ",null,null,null,null,null,"件"]
[]
[null,"※以上粗框內資訊為報告必出之欄位，若未填寫視同無，報告則將出具「-」。產品名稱、保存方式和數量為必填。"]
["委託\n檢測\n項目","※同一份委託單上載明之所有委託檢驗項目，其檢驗結果應以同一份測試報告出具。"]
[null,"※務必提供足量樣品進行測試，若事後補樣均視為不同樣品，並不與原報告結果一同出具。"]
[null,"※若未指定檢測方法，即同意SGS依樣品基質以最適方法進行檢測。"]
[]
[]
[]
["服務件別","報告服務類別:",null,null,null,null,null,null," 普通件",null,null,null,null," 急件(費用加40%)",null,null,null,null,null,null,null," 特急件(費用加96%)"]
[null,"※急件或特急件之檢驗服務，送驗前請先來電洽詢(工作天數:收樣當日及例假日不計入)。 \n※預出報告當天僅提供報告電子檔，正本報告為隔日提供自取或寄出服務。"]
["報告需求",1,"報告使用目的：",null,null,null,null,null,"自主管理",null,null,null,null,"出口使用",null,null,null,null,"食品衛生法規要求"]
[null,2,"報告提供方式:",null,null,null,null,null,"電子檔",null,null,null,null,"傳真",null,null,null,null,"兩者都需要"]
[null,3,"報告語言:",null,null,null,null,null,"中文報告",null,null,null,null,"英文報告(英文資訊請主動提供)如勾選兩種以上，將酌收行政作業費368元"]
[null,4,"取紙本報告方式:",null,null,null,null,null,"普掛郵寄",null,null,null,null,"自取(超過三天未自取者將逕行寄出)"]
[null,5,null,"測試報告QR code(此QR code將顯示在該份測試報告上做為期兩年的真實性查證用)，申請將酌收行政作業費105元。"]
["注意\n事項","敬告 貴客戶:\n1.貴客戶所提供的測試樣品，會因取樣與測試需要，而造成樣品之減損與破壞；且本公司對於送驗之常溫樣品僅保留20天/冷凍.冷藏樣品保留7天(由出報告日起算)，除非貴客戶另有要求(退樣)且記載於申請書上，否則將會另作處置。\n2.若取消測試檢驗則酌收前處理費即測試費的一半(收件日當天取消不列入)。\n3.申請者應保證所提供資料真實性及正當性，確保申請廠商、報告抬頭廠商、生產與供應商知悉且同意揭露於正式報告中，若有提供虛偽不實之情形，申請人應承擔相關法律責任。報告以申請書資訊為主，報告出具後，內容一律不得更改。\n4.測試報告出具天數為所有委託檢驗項目中最長之天數。\n5.實驗室承諾，除法律要求外，對在執行實驗室活動中所獲得或產生的所有資訊予以保密。\n6.本實驗室不於測試報告中提供符合性聲明與量測不確定度。\n7.因申請書版面限制，無法於申請書上明述實驗方法與檢驗範圍等相關資訊，如您需要確認實驗方法與檢驗範圍等相關資訊時，\n煩請自行至實驗方法與檢驗範圍等資訊的網路連結(http://twap.sgs.com/sgssip/?c=42HTH)查詢或掃描右方的QR Code。"]
["簽名",null,"同意上傳",null,null,null,"※我願意授權SGS將測試結果主動上傳至SGS安心資訊平台，SGS保有最終上傳與否之審核權力。         ",null,null,null,null,null,null,null,null,null,null,null,null,null,"上述提供資料皆正確無誤,\n申請人簽名:\n",null,null,null,null,null,"___________________________"]
[null,null,"不同意上傳"]
["1.本申請廠商申請上述之檢驗，同意所有試驗依本公司所訂之測試服務條款履行。2本公司之通用服務條款可在本公司網站http://www.sgs.com/en/terms-and-conditions.aspx閱覽。3.如未附報價單，以本公司定價為主。4.因本件檢驗及其檢驗費用涉訟時,雙方當事人同意以台灣台北地方法院為第一審管轄法院。 \n文件編碼:FOOD-F-01-20190902                                                                                                                                                            "]

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["*委託檢測項目: ※同一樣品於一份檢驗委託單上載明之所有委託檢驗項目，其檢驗結果應以同一份檢驗報告出具。"]
["1、SGS多重農藥殘留檢測 "]
[null," SGS多重農殘檢測373項",null,null,null,null,null,null," SGS多重農殘檢測374項含二硫代",null,null,null,null,null,null,null,null,null,"SGS多重農殘檢測473項(※有外銷目的之自主管理者適用)"]
[null," SGS多重農殘檢測380項",null,null,null,null,null,null," SGS多重農殘檢測381項含二硫代"]
["2、SGS多重農藥殘留檢測(禽畜類) "]
[null,"SGS禽畜產品多重農藥殘留60項(肌肉、內臟)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SGS禽畜產品多重農藥殘留126項(肌肉、內臟、蛋)"]
["3、人工添加劑"]
["添加劑：",null,"     防腐劑5項(酸類)",null,null,null,null,null,"防腐劑7項(酯類)",null,null,null,null,null,null,"防腐劑-丙酸",null,null,null,null,null,null,null,"甜味劑4項 ",null,null,null,null,null,null," 多重甜味劑10項"]
[null,null,"抗氧化劑11項",null,null,null,null,null," 亞硝酸鹽(保色劑)",null,null,null,null,null,"       硼酸及其鹽類"]
["漂白劑：",null,null,"二氧化硫(食品)",null,null,null,null,"二氧化硫(冷凍蝦)",null,null,null,null,null,null,"二氧化硫(冷藏蝦、活蝦) ",null,null,null,null,null,null,null,"過氧化氫"]
["色素：",null,null,"食用色素8項(食品)",null,null,null,null,"16項色素(適合飲料.糖果) "]
["4、毒素定量"]
[null,"總黃麴毒素(Alfatoxin B1.B2.G1.G2)",null,null,null,null,null,null,null,"  黃麴毒素M1",null,null,null,null,null,"赭麴毒素",null,null,null,null,"棒麴毒素",null,null,null,null,null,"橘黴素( Citrinin )"]
[null,"鐮刀黴菌毒素T-2及HT-2",null,null,null,null,null,null,null,"伏馬毒素B1及B2",null,null,null,null,null,"多重毒素",null,null,null,null,"脫氧雪腐鐮刀菌烯醇"]
["5、營養標示                ",null,null,null,null," ※ 驗八大營養標示/美國FDA營養標示(新版):每一份量                   公克/毫升，本包裝含      份(請提供整數)"]
[null,"八大營養標示",null,null,null,null,null,"膳食纖維",null,null,null,null,null,null,null,"八大營養標示+膳食纖維",null,null,null,null,null,null,null,null,null,null,"五大營養標示"]
[null,"香港九項營養標示",null,null,null,null,null,"美國FDA營養標示(新版)",null,null,null,null,null,null,null,"五大營養標示(大陸使用)"]
["※茶湯驗營養標示請提供沖泡條件：樣品",null,null,null,null,null,null,null,null,null,null,"(g)茶葉，沖泡",null,null,null,null,null,"(ml)的水，",null,null,null,null,null,"(度)水溫沖泡",null,null,null,null,null,null,"分鐘"]
["6.微生物(以衛福部公告為主，如有指定方法請另列________________ )"]
[null,"生菌數",null,null,null,null,"大腸桿菌",null,null,null,null,null,"大腸桿菌群",null,null,null,null,"金黃色葡萄球菌",null,null,null,null,null,null,null,"沙門氏桿菌"]
[null,"黴菌&酵母菌",null,null,null,null,"腸桿菌科",null,null,null,null,null,"李斯特菌",null,null,null,null,"仙人掌桿菌",null,null,null,null,null,null,null,"金黃色葡萄球菌腸毒素(AOAC方法)"]
[null,"糞便性鏈球菌",null,null,null,null,"綠膿桿菌",null,null,null,null,null,"腸炎弧菌",null,null,null,null,"阪崎腸桿菌",null,null,null,null,null,null,null,"黴菌(參考)",null,null,null,null,null,"酵母菌(參考)"]
["7.重金屬： "]
[null,"食用油脂：砷(As)、鉛(Pb)、汞(Hg)",null,null,null,null,null,null,null,null,null,"食米：汞(Hg)、鎘(Cd)、鉛(Pb)            ;",null,null,null,null,null,null,null,null,null,null,null,null,null,"食米：無機砷 "]
[null,"食用菇類：鉛(Pb)、鎘(Cd)",null,null,null,null,null,null,null,null,null,"水產動物類(生鮮)：甲基汞、鉛(Pb)、鎘(Cd)  ;",null,null,null,null,null,null,null,null,null,null,null,null,null,"水產動物類(生鮮)：無機砷 "]
[null,"蛋類：鉛(Pb) 銅(Cu)",null,null,null,null,null,null,null,null,null,"飲料類：砷(As)、鉛(Pb)、銅(Cu)；",null,null,null,null,null,null,null,null,null,null,null,null,null,"銻(Sb) (飲料以PET容器包裝者需加測)"]
[null,"食用冰塊：砷(As)、鉛(Pb)、汞(Hg)",null,null,null,null,null,null,null,null,null,"包裝飲用水：砷(As)、鉛(Pb)、汞(Hg)、鎘(Cd)；",null,null,null,null,null,null,null,null,null,null,null,null,null,"銻(Sb) (水以PET容器包裝者需加測)"]
[null,"禽畜產品類：鉛(Pb)、鎘(Cd)",null,null,null,null,null,null,null,null,null,"食用藻類：鉛(Pb)、鎘(Cd)、汞(Hg)　；",null,null,null,null,null,null,null,null,null,null,null,null,null,"食用藻類：無機砷 "]
[null,"蔬果類：鉛(Pb)、鎘(Cd)",null,null,null,null,null,null,null,null,null,"嬰兒食品：鉛(Pb)、鎘(Cd)",null,null,null,null,null,null,null,null,null,null,null,null,null,"乳品類:鉛(Pb)"]
[null,"麥、穀類：砷(As)、鉛(Pb)、鎘(Cd)",null,null,null,null,null,null,null,null,null,"果汁類：鉛(Pb)；",null,null,null,null,null,null,null,null,null,null,null,null,null,"銻(Sb) (果汁以PET容器包裝者需加測)"]
[null,"食鹽:鉛(Pb)、汞(Hg)、砷(As)、銅(Cu)、鎘(Cd)",null,null,null,null,null,null,null,null,null,"金屬罐頭：鉛(Pb)、錫(Sn)",null,null,null,null,null,null,null,null,null,null,null,null,null,"錫(Sn) ※若產品以金屬罐裝需加測"]
["定量極限：      2.0ppm:           0.01ppm:",null,null,null,null,null,null,null,null,null,null,"砷(As)、",null,null,"鉛(Pb)、",null,null,"鎘(Cd)、",null,null,null,"汞(Hg)、",null,null,null,"銅(Cu)、",null,null,null,"其他元素：",null,null,null,null,"                  "]
["8.酒類測項："]
["  　甲醇＋鉛＋二氧化硫+乙醇 ",null,null,null,null,null,null,"     ","甲醇＋鉛＋乙醇",null,null,null,null,null,"甲醇",null,null,"乙醇",null,null,null,null,"鉛",null,null,null,"二氧化硫"]
["        防腐劑(己二烯酸)",null,null,null,null,null,null,"     ","防腐劑(苯甲酸)",null,null,null,null,null,"其他 ",null,"                    "]
["9、可塑劑測項：  "]
["   九種塑化劑",null,null,null,"         ",null,null,null,"十八種塑化劑(大陸規定)  "]
["10、動物用藥/抗生素相關檢測：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"若產品為進口生鮮魚蝦類請打勾:",null,null,null,null,null,null,null,null,null,null," (若未勾選皆視為國內養殖魚蝦類)     ",null,null,null,null,null,null,null,null,null,null," "]
[null,"孔雀綠與還原型孔雀綠",null,null,null,null,null,"硝基呋喃代謝物( 4項)",null,null,null,null,null,null,"氯黴素類(4項)",null,null,null,null,"多重殘留分析(抗原蟲劑)7項",null,null,null,null,null,null,null,null,null,null,"胺基醣苷類"]
[null,"四環黴素類( 7項)",null,null,null,null,null,"瘦肉精(乙型瘦體素(21項) ",null,null,null,null,null,null,"多重殘留分析48項(含磺胺類、氟奎諾酮類、抗菌劑類)"]
[null,"β-內醯胺類抗生素( 8項)",null,null,null,null,null,"離子型抗球蟲",null,null,null,null,null,null,"抗生素及其代謝物多重殘留分析(16項)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Avermectin類"]
["11、食用油脂："]
[null,"苯駢芘(BaP)",null,null,"      多環芳香族碳氫化合物(BaA、Chrysene、BbF、BaP)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"芥酸",null,null,null,null,"酸價"]
[null,"過氧化價",null,null,"          總極性物質",null,null,null,null,null,null,"脂肪酸組成",null,null,null,null,"膽固醇",null,null,null,null,null,null,"反式脂肪酸",null,null,null,null,"碘價"]
["12、其他："]
["        三聚氰胺  ",null,null,null,"   揮發性鹽基態氮",null,null,null,null,null,null,"咖啡因",null,null,null,null," 3-單氯丙二醇",null,null,null,null,null,null,"丙烯醯胺",null,null,null,null,"組織胺"]
[null,"水解胺基酸18項",null,null,null,null,null,null,null,null,null,"其他："]
["申請人簽名：                                       "]
[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,"文件編碼:FOOD-F-01-20190902"]

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[]
[null,248,null,null,"新北市五股區五工路125號4F"]
[null,null,null,null,"台灣檢驗科技股份有限公司"]
["     ",null,null,null,"台北食品服務部- ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"收"]
[null,null,null,null,"Tel: 02-2299-3279 "]
[null,null,null,null,"Fax: 02-2299-1687"]
[]
[]
[]
[null,407,null,null,"台中市西屯區工業區十四路9號"]
[null,null,null,null,"台灣檢驗科技股份有限公司"]
[null,null,null,null,"台中食品服務部- ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"收"]
[null,null,null,null,"Tel: 04-23591515"]
[null,null,null,null,"Fax: 04-23592948"]
[]
[]
[]
[null,811,null,null,"高雄市楠梓加工區開發路61號"]
[null,null,null,null,"台灣檢驗科技股份有限公司"]
[null,null,null,null,"高雄食品服務部- ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"收"]
[null,null,null,null,"Tel: 07-3012121 "]
[null,null,null,null,"Fax: 07-3012867 "]