Questionnaire

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LEGAL COMPLIANCE YES NO

Europe: (Regulation (EC) No 1334/2008 of the European Parliament and of the Council
of 16 December 2008 on flavorings and certain food ingredients with flavoring properties   X
for use in foods)
LEGAL DESIGNATION OF THE AROMATIC PART
Europe: (Regulation (EC) No 1334/2008 of the European Parliament and of the Council
of 16 December 2008 on flavorings and certain food ingredients with flavoring properties
for use in foods)

Compliance with current legislation. Treatment of foodstuffs with


No If so, indicate which  
ionizing radiations.
Ingredients or coadyuvants which have been irradiated, or have
No If so, indicate which  
been manufactured from irradiated ones.
OGM´s.
In compliance with OMG labelling regulation. Yes If so, indicate which  
Ingredients or processing aids which contain or are formed by
GMO*, or have been developed from GMO or which contain No If so, indicate which  
ingredients made from these organisms.

PHYSICAL RISK
The risk is present: Yes / No Declaraded
Shells < 0.005%      
Scrapes / pigtails  No      
Own Process
Field Stones products  No      
Bones  No      
Metals No      
Glasses No      
Plastics No
Outside of the No
Woods      
process
Insulators (rubber) No      
Tarps, thread ... No      
Personal effects No      
Cardboard, paper etc. No      
Packaging No
Plastic      
source
Metal chips No
Other risks not contemplated or
emerging
 
Preventive Measures against physical hazards. Mm
Last filter size  12 mm
Filters, screens, sieves, …
Smaller size filter  6 mm
Magnetic tramp NO X
Artificial vision X YES
Ferric  1,5
Metal detector, X - Ray, … NO X Witnesses Size No Ferric  1,8
Stainless  2,0

Product PACKAGING

The supplier undertakes to comply with current legislation on plastic materials and articles intended to come into contact with
foodstuffs (packaging suitable for food use) and compliance with current legislation on packaging migration.
Indicate net weight and format of the unit of sale: 2 x 5,0 Kg
Indicate the material the package is made of (from inside out, stating its colour)  
 vacuum PA/PE transparent/blue bag
and the closure system (string –indicating colour–, thermal sealing, etc) packed in cardboard box 
 
Use approved simulants. X YES ¿Which?  
Ink and adhesive used for impression and lamination
observe the laws in force in relation to the materials used for X YES ¿Which?  
the impression of food products packaging.
Indicate if the package is made of recycled material or X % ¿Which?  
contains a percentage of recycled material. If so, indicate the NO
percentage of recycled material.
Attach declaration of conformity of the containers used in accordance with the Regulations. 10/2011
Attach packaging migration study

TRACEABILITY
In compliance with the current legislation in relation to traceability. NO X
Ahmet Sahin, Avellana AS GmbH Kölner Straße 180-182
Indicate contact person and contact information in case of food
50226 Frechen, +49 (0) 172 65 86 425 ;
crisis (name, post, 24 hours telephone, mail).
Ahmet@avellana.de  

CHAPTER III. SUPPLIER REQUIREMENTS


Please, tick the correct cell with an “X”
1.- The supplier commits himself to use metallized film packaging for food use whenever
X YES
possible.
2. - If the above is not possible, the provider agrees to use as primary packaging material
X YES
detectable blue or sight.
3.- The supplier commits himself to use thermal sealing whenever possible. NO X
4.- The supplier commits himself not to use any products or materials which may contain latex
X
in his manufacturing processes.
5. - The supplier is committed to making the lot / batch and the best before date or expiration,
X
provided in each individual package.
6. - The provider agrees to use plastic pallets for delivery of the goods. X YES
We could deliver the cargo for you on H1 Paletts that’s no problem. In Standard they are
packed on Euro- Pallets.

Chapter IV. PRODUCT CONTROLS:


Please, tick the correct cell with an “X”
RAW MATERIAL’S ORIGIN
Country of origin of the raw material: Republic of Moldova  
Origin. animal vegetal synthesis
Analysis at source (Manufacturer) Analysis at the reception facilities of the supplier that
distributes to Estiu Ice Cream
(in case of being a distributor)
Sampling Authorized Authorized
Parameters Frequency (Ex.: per batch, Laboratory Parameters Frequency Sampling Laboratory
per order, etc.) (Y/N) (Y/N)
Humidity  Per batch      Intern lab      
 Acidity Per batch    Intern lab        
Water activity  Per batch    Intern lab        
 Peroxide level Per batch    Intern lab        
Organoleptic   Per batch    Intern lab        
               

               
               
               

               

CHAPTER V. GESTIÓN MEDIOAMBIENTAL


Please, tick the correct cell with an “X”
Do you have any environmental management certificate: ISO 14001, EMAS ... (attach certified copy). X YES
Otherwise, complete the attached questionnaire of "Supplier Self-Assessment"
CHAPTER VI. ETHICAL AND SOCIAL RESPONSABILITY
Please, tick the correct cell with an “X”

Do you have a certified Social Responsibility System: SA8000, GRI, SR10, etc. (attach certified copy)
If not, complete the attached questionnaire on Social Responsibility. Only manufacturers located outside X YES
the EU
Have you developed with your suppliers an ethical trading strategy according to your code or ethical
X YES
policy.
Commit to the principles of the United Nations Global Compact X YES
http://www.pactomundial.org/category/learning/10-principles/

CHAPTER VII. COMPLEMENTARY


INFORMATION:
Please, tick the correct cell with an “X”

Indicate the number of the Sanitary Register and attach a copy of it. Nº Date
In Suppliers from outside Spain the RGSA is not obligatory except for suppliers of products of
animal origin. Depending on the countries, there may be similar records as the Packer Number
in France (EMB).
Do you have any ISO, BRC, IFS, AIB, FSSC 22000, ISO 22000, RSPO, UTZ, etc. certification? (if yes attach copy)
If you do not have a certificate, complete the attached questionnaire of "Supplier Self-Assessment"
Certification ISO 9001 IFS BRC AIB FSSC 22000 ISO 22000 Others
Validity date            
 
If you have an IP certificate for the absence of GMOs (Genetically Modified Organisms), please
NO X
attach
Do you have an HACCP system NO X

Attach Flow Diagram (Indicate the presence of filters in each stage, as well as their light size, indicate the presence of metal
detector if any and / or X-rays, as well as any system that eliminates the presence of foreign bodiers in final product)

Attach CCP Management Chart

Attach the updated Technical Data Sheet of the raw material supplied NO X
In the case of a chemical product, attach updated Safety Data Sheet of the supplied raw
NO X
material

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