+----+-----------------------------------+-------------------+---+----+
| ** |                                   |                   |   |    |
| DE |                                   |                   |   |    |
| PA |                                   |                   |   |    |
| RT |                                   |                   |   |    |
| ME |                                   |                   |   |    |
| NT |                                   |                   |   |    |
| OF |                                   |                   |   |    |
| HE |                                   |                   |   |    |
| AL |                                   |                   |   |    |
| TH |                                   |                   |   |    |
| A  |                                   |                   |   |    |
| ND |                                   |                   |   |    |
| H  |                                   |                   |   |    |
| UM |                                   |                   |   |    |
| AN |                                   |                   |   |    |
| SE |                                   |                   |   |    |
| RV |                                   |                   |   |    |
| IC |                                   |                   |   |    |
| ES |                                   |                   |   |    |
| ** |                                   |                   |   |    |
|    |                                   |                   |   |    |
| ** |                                   |                   |   |    |
| FO |                                   |                   |   |    |
| OD |                                   |                   |   |    |
| A  |                                   |                   |   |    |
| ND |                                   |                   |   |    |
| DR |                                   |                   |   |    |
| UG |                                   |                   |   |    |
| AD |                                   |                   |   |    |
| MI |                                   |                   |   |    |
| NI |                                   |                   |   |    |
| ST |                                   |                   |   |    |
| RA |                                   |                   |   |    |
| TI |                                   |                   |   |    |
| ON |                                   |                   |   |    |
| ** |                                   |                   |   |    |
|    |                                   |                   |   |    |
| ** |                                   |                   |   |    |
| BE |                                   |                   |   |    |
| VE |                                   |                   |   |    |
| RA |                                   |                   |   |    |
| GE |                                   |                   |   |    |
| P  |                                   |                   |   |    |
| LA |                                   |                   |   |    |
| NT |                                   |                   |   |    |
| IN |                                   |                   |   |    |
| SP |                                   |                   |   |    |
| EC |                                   |                   |   |    |
| TI |                                   |                   |   |    |
| ON |                                   |                   |   |    |
| RE |                                   |                   |   |    |
| PO |                                   |                   |   |    |
| RT |                                   |                   |   |    |
| ** |                                   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 1  |                                   | 2\. DATE          |   |    |
| \. |                                   | INSPECTED         |   |    |
| E  |                                   |                   |   |    |
| ST |                                   |                   |   |    |
| AB |                                   |                   |   |    |
| LI |                                   |                   |   |    |
| SH |                                   |                   |   |    |
| ME |                                   |                   |   |    |
| NT |                                   |                   |   |    |
| NA |                                   |                   |   |    |
| ME |                                   |                   |   |    |
| A  |                                   |                   |   |    |
| ND |                                   |                   |   |    |
| A  |                                   |                   |   |    |
| DD |                                   |                   |   |    |
| RE |                                   |                   |   |    |
| SS |                                   |                   |   |    |
| *  |                                   |                   |   |    |
| (I |                                   |                   |   |    |
| nc |                                   |                   |   |    |
| lu |                                   |                   |   |    |
| de |                                   |                   |   |    |
| Z  |                                   |                   |   |    |
| IP |                                   |                   |   |    |
| co |                                   |                   |   |    |
| de |                                   |                   |   |    |
| )* |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
|    |                                   | 3\. STATE LICENSE |   |    |
|    |                                   | OR PERMIT NUMBER  |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 4  |                                   | 8\. TELEPHONE     |   |    |
| \. |                                   | NUMBER *(Include  |   |    |
| NA |                                   | Area Code)*       |   |    |
| ME |                                   |                   |   |    |
| OF |                                   |                   |   |    |
| O  |                                   |                   |   |    |
| WN |                                   |                   |   |    |
| ER |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 6  |                                   | 7\. TELEPHONE     |   |    |
| \. |                                   | NUMBER *(Include  |   |    |
| NA |                                   | Area Code)*       |   |    |
| ME |                                   |                   |   |    |
| OF |                                   |                   |   |    |
| M  |                                   |                   |   |    |
| AN |                                   |                   |   |    |
| AG |                                   |                   |   |    |
| ER |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
|    |                                   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| I  |                                   |                   |   |    |
| NS |                                   |                   |   |    |
| TR |                                   |                   |   |    |
| UC |                                   |                   |   |    |
| TI |                                   |                   |   |    |
| ON |                                   |                   |   |    |
| S: |                                   |                   |   |    |
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| sw |                                   |                   |   |    |
| er |                                   |                   |   |    |
| t  |                                   |                   |   |    |
| he |                                   |                   |   |    |
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| he |                                   |                   |   |    |
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| pp |                                   |                   |   |    |
| ro |                                   |                   |   |    |
| pr |                                   |                   |   |    |
| ia |                                   |                   |   |    |
| te |                                   |                   |   |    |
| bo |                                   |                   |   |    |
| x. |                                   |                   |   |    |
| E  |                                   |                   |   |    |
| xp |                                   |                   |   |    |
| la |                                   |                   |   |    |
| in |                                   |                   |   |    |
| \  |                                   |                   |   |    |
| "N |                                   |                   |   |    |
| o\ |                                   |                   |   |    |
| ", |                                   |                   |   |    |
| a  |                                   |                   |   |    |
| ns |                                   |                   |   |    |
| we |                                   |                   |   |    |
| rs |                                   |                   |   |    |
| on |                                   |                   |   |    |
| co |                                   |                   |   |    |
| nt |                                   |                   |   |    |
| in |                                   |                   |   |    |
| ua |                                   |                   |   |    |
| ti |                                   |                   |   |    |
| on |                                   |                   |   |    |
| s  |                                   |                   |   |    |
| he |                                   |                   |   |    |
| et |                                   |                   |   |    |
| (s |                                   |                   |   |    |
| ). |                                   |                   |   |    |
| P  |                                   |                   |   |    |
| re |                                   |                   |   |    |
| ce |                                   |                   |   |    |
| de |                                   |                   |   |    |
| ea |                                   |                   |   |    |
| ch |                                   |                   |   |    |
| e  |                                   |                   |   |    |
| xp |                                   |                   |   |    |
| la |                                   |                   |   |    |
| na |                                   |                   |   |    |
| ti |                                   |                   |   |    |
| on |                                   |                   |   |    |
| wi |                                   |                   |   |    |
| th |                                   |                   |   |    |
| t  |                                   |                   |   |    |
| he |                                   |                   |   |    |
| it |                                   |                   |   |    |
| em |                                   |                   |   |    |
| n  |                                   |                   |   |    |
| um |                                   |                   |   |    |
| be |                                   |                   |   |    |
| r. |                                   |                   |   |    |
| U  |                                   |                   |   |    |
| se |                                   |                   |   |    |
| \  |                                   |                   |   |    |
| "N |                                   |                   |   |    |
| /A |                                   |                   |   |    |
| \" |                                   |                   |   |    |
| w  |                                   |                   |   |    |
| he |                                   |                   |   |    |
| re |                                   |                   |   |    |
| q  |                                   |                   |   |    |
| ue |                                   |                   |   |    |
| st |                                   |                   |   |    |
| io |                                   |                   |   |    |
| ns |                                   |                   |   |    |
| a  |                                   |                   |   |    |
| re |                                   |                   |   |    |
| N  |                                   |                   |   |    |
| ot |                                   |                   |   |    |
| A  |                                   |                   |   |    |
| pp |                                   |                   |   |    |
| li |                                   |                   |   |    |
| ca |                                   |                   |   |    |
| bl |                                   |                   |   |    |
| e. |                                   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| *  | **STORAGE CONDITIONS**            |                   | * | ** |
| *N |                                   |                   | * | NO |
| O. |                                   |                   | Y | ** |
| ** |                                   |                   | E |    |
|    |                                   |                   | S |    |
|    |                                   |                   | * |    |
|    |                                   |                   | * |    |
+----+-----------------------------------+-------------------+---+----+
| 1  | Is water supply used for          |                   |   |    |
| \. | manufacturing purposes from an    |                   |   |    |
|    | approved source and of            |                   |   |    |
|    | satisfactory quality              |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 2  | Are stocks of liquid and/or dry   |                   |   |    |
| \. | sugar stored under conditions     |                   |   |    |
|    | which prevent adulteration by     |                   |   |    |
|    | rodents, insects, mold, etc.      |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 3  | Are beverage bases, concentrates, |                   |   |    |
| \. | colors, flavors, and other raw    |                   |   |    |
|    | materials stored in clean         |                   |   |    |
|    | containers, which are properly    |                   |   |    |
|    | identified and adequately protect |                   |   |    |
|    | contents                          |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 4  | Are new bottles, cans, and crowns |                   |   |    |
| \. | stored off the floor and          |                   |   |    |
|    | protected from contamination.     |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 5  | Are finished product sufficiently |                   |   |    |
| \. | separated from mixing and filling |                   |   |    |
|    | areas so that contamination will  |                   |   |    |
|    | not occur                         |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 6  | Is plant free from evidence of    |                   |   |    |
| \. | domestic pets, rodent, insect or  |                   |   |    |
|    | bird activity                     |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| *  |                                   |                   |   |    |
| *M |                                   |                   |   |    |
| AN |                                   |                   |   |    |
| UF |                                   |                   |   |    |
| AC |                                   |                   |   |    |
| TU |                                   |                   |   |    |
| RI |                                   |                   |   |    |
| NG |                                   |                   |   |    |
| P  |                                   |                   |   |    |
| RO |                                   |                   |   |    |
| CE |                                   |                   |   |    |
| SS |                                   |                   |   |    |
| ES |                                   |                   |   |    |
| ** |                                   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 7  | Are tanks, vats, transfer lines,  |                   |   |    |
| \. | mixers, and other equipment used  |                   |   |    |
|    | for mixing, storage, and transfer |                   |   |    |
|    | of syrups constructed of smooth,  |                   |   |    |
|    | impervious, non-toxic materials   |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 8  | Does firm adequately clean and    |                   |   |    |
| \. | sanitize syrup mixing and         |                   |   |    |
|    | transfer equipment before use     |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 9  | Is syrup room clean, in good      |                   |   |    |
| \. | repair, and generally free of     |                   |   |    |
|    | potential contaminants            |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 10 | Are single-use containers rinsed  |                   |   |    |
| \. | or inspected prior to filling     |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 11 | Are product lines and equipment   |                   |   |    |
| \. | maintained in a mold-free         |                   |   |    |
|    | condition                         |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 12 | Are multi-use bottles inspected   |                   |   |    |
| \. | for filth or foreign objects      |                   |   |    |
|    | after wash, but prior to fill     |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 13 | Are returned multi-use bottles    |                   |   |    |
| \. | containing foreign objects or     |                   |   |    |
|    | excessive filth rejected prior to |                   |   |    |
|    | entering the washer               |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 14 | Is bottle washer operating        |                   |   |    |
| \. | properly with respect to water    |                   |   |    |
|    | pressure and temperature, soak    |                   |   |    |
|    | time, caustic concentration,      |                   |   |    |
|    | mechanical brushing, and rinsing  |                   |   |    |
+----+-----------------------------------+-------------------+---+----+
| 15 | Are filling and capping           |                   |   |    |
| \. | operations conducted under        |                   |   |    |
|    | satisfactory sanitary conditions  |                   |   |    |
+----+-----------------------------------+-------------------+---+----+

+----+---+-------------------------------------------------------+---+---+
| ** |   |                                                       |   |   |
| IN |   |                                                       |   |   |
| SP |   |                                                       |   |   |
| EC |   |                                                       |   |   |
| TI |   |                                                       |   |   |
| ON |   |                                                       |   |   |
| CR |   |                                                       |   |   |
| IT |   |                                                       |   |   |
| ER |   |                                                       |   |   |
| IA |   |                                                       |   |   |
| ** |   |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+
| *  |   | **MANUFACTURING PROCESSES (Cont.)**                   | * | * |
| *N |   |                                                       | * | * |
| O. |   |                                                       | Y | N |
| ** |   |                                                       | E | O |
|    |   |                                                       | S | * |
|    |   |                                                       | * | * |
|    |   |                                                       | * |   |
+----+---+-------------------------------------------------------+---+---+
| 16 |   | Are bottled beverage production lines operating       |   |   |
| \. |   | without apparent excessive glass breakage             |   |   |
+----+---+-------------------------------------------------------+---+---+
| 17 |   | Does post-fill inspection procedure *(visual or       |   |   |
| \. |   | mechanical)* appear to be effective                   |   |   |
+----+---+-------------------------------------------------------+---+---+
| 18 |   | Were food / color additives or pesticides used        |   |   |
| \. |   | properly                                              |   |   |
+----+---+-------------------------------------------------------+---+---+
| 19 |   | Do labels of products covered during inspection       |   |   |
| \. |   | comply with Fair Packaging and Labeling Act           |   |   |
+----+---+-------------------------------------------------------+---+---+
| 20 |   | Does examination of warehouse stock reveal finished   |   |   |
| \. |   | product to be free of mold or other visible filth     |   |   |
+----+---+-------------------------------------------------------+---+---+
| ** |   |                                                       |   |   |
| BU |   |                                                       |   |   |
| IL |   |                                                       |   |   |
| DI |   |                                                       |   |   |
| NG |   |                                                       |   |   |
| A  |   |                                                       |   |   |
| ND |   |                                                       |   |   |
| G  |   |                                                       |   |   |
| RO |   |                                                       |   |   |
| UN |   |                                                       |   |   |
| DS |   |                                                       |   |   |
| ** |   |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+
| 21 | A |                                                       |   |   |
| \. | r |                                                       |   |   |
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|    | s |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+
| 22 | I |                                                       |   |   |
| \. | s |                                                       |   |   |
|    | b |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| 23 | A |                                                       |   |   |
| \. | r |                                                       |   |   |
|    | e |                                                       |   |   |
|    | d |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| 24 | A |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| 25 | A |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| 26 | D |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| 27 | A |                                                       |   |   |
| \. | r |                                                       |   |   |
|    | e |                                                       |   |   |
|    | i |                                                       |   |   |
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|    | d |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+
| *  |   |                                                       |   |   |
| *T |   |                                                       |   |   |
| RA |   |                                                       |   |   |
| NS |   |                                                       |   |   |
| PO |   |                                                       |   |   |
| RA |   |                                                       |   |   |
| TI |   |                                                       |   |   |
| ON |   |                                                       |   |   |
| P  |   |                                                       |   |   |
| RA |   |                                                       |   |   |
| CT |   |                                                       |   |   |
| IC |   |                                                       |   |   |
| ES |   |                                                       |   |   |
| ** |   |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+
| 28 | A |                                                       |   |   |
| \. | r |                                                       |   |   |
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|    | v |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| 29 | A |                                                       |   |   |
| \. | r |                                                       |   |   |
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|    | r |                                                       |   |   |
|    | t |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+
| *  |   |                                                       |   |   |
| *T |   |                                                       |   |   |
| OI |   |                                                       |   |   |
| LE |   |                                                       |   |   |
| T, |   |                                                       |   |   |
| DR |   |                                                       |   |   |
| ES |   |                                                       |   |   |
| SI |   |                                                       |   |   |
| NG |   |                                                       |   |   |
| RO |   |                                                       |   |   |
| OM |   |                                                       |   |   |
| S, |   |                                                       |   |   |
| A  |   |                                                       |   |   |
| ND |   |                                                       |   |   |
| E  |   |                                                       |   |   |
| MP |   |                                                       |   |   |
| LO |   |                                                       |   |   |
| YE |   |                                                       |   |   |
| ES |   |                                                       |   |   |
| ** |   |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+
| 30 | A |                                                       |   |   |
| \. | r |                                                       |   |   |
|    | e |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
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+----+---+-------------------------------------------------------+---+---+
| 32 | A |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| 33 | D |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
| *  |   |                                                       |   |   |
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+----+---+-------------------------------------------------------+---+---+
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+----+---+-------------------------------------------------------+---+---+
| 35 |   |                                                       |   |   |
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| s. |   |                                                       |   |   |
|    |   |                                                       |   |   |
|    |   |                                                       |   |   |
|    |   |                                                       |   |   |
|    |   |                                                       |   |   |
+----+---+-------------------------------------------------------+---+---+

+------------------------------------------------------+---------------+
| **DISCUSSION WITH MANAGEMENT**                       |               |
+------------------------------------------------------+---------------+
| Indicate individual with whom inspection was         |               |
| discussed. Identify official (name and title) having |               |
| authority to authorize corrections. Record any       |               |
| recommendations and / or warnings given, and         |               |
| management\'s responses.                             |               |
|                                                      |               |
|                                                      |               |
+------------------------------------------------------+---------------+
| **CONTINUATION SHEET**                               |               |
+------------------------------------------------------+---------------+
| *(Use additional sheets as appropriate.)*            |               |
|                                                      |               |
|                                                      |               |
+------------------------------------------------------+---------------+
| SIGNATURE OF INSPECTOR                               | DATE          |
|                                                      |               |
|                                                      |               |
+------------------------------------------------------+---------------+