Fillable Printable Re-evaluation Form - California

Re-evaluation Form - California

State of California – Health and Human Services Agency California Department of Public Health

Food and Drug Branch

REQUEST FOR pH RE-EVALUATION FORM

Revised 11/2012

Canner: Product:

Mailing Address: Formula Number/Code:

City: Zip Code: Telephone:

XT ____________

Existing S-Number

S-_________________

and Date of Existing Process Letter __________________________

NOTE: Highlight changes in formula. If changes are determined to be significant, a

new formula number must be assigned.

Container Size(s):

Sample(s) submitted

Yes No

If yes,

Laboratory Sample or Production Sample

INGREDIENTS: (List each ingredient by weight or percentage; and describe ingredient (fresh, frozen, dried, brined, canned, acidified,

etc.). Give pH if known. Attach extra sheet if needed.

Ingredient: Amount (Wt or %) Ingredient: Amount (Wt or %)

Product Preparation: Indicate process

Cold-Fill Pasteurizer/ Water Bath Hot-Fill-Hold Other

Include minimum initial temperature where necessary. Indicate minimum time and temperature that the product is heated

and EXACTLY what parameters are monitored. Attach extra sheet, if needed.

For HOT FILL HOLD: Also include minimum temperature upon filling into the container, how long the product is held in the container

prior to cooling and how the container lid is sterilized – for example: is the container inverted?

pH of acid ingredient(s) alone or with water (if added): Equilibrium pH after low-acid ingredients are mixed-in but before any acid is added:

Equilibrium pH of finished product: Approximate time needed to achieve equilibrium pH:

For products where primary acidification is by addition of acid to a low-acid main ingredient (eg. cucumbers, peppers):

A. If food is acid-blanched:

What Acid is Used? % Acid in bath? Time: Temperature: pH of food after blanching:

B: If Acid blanching is not used, how is acidification achieved?

For product with Water Activity ≤ 0.85, give equilibrium Water Activity of finished product (describe method

used:

Signature (required): Date:

Print Name (required): Title:

Submit to: University of California Tel: (925) 833-6941

Laboratory for Research in Food Preservation Fax: (925) 833-9739

6665 Amador Plaza Road, Suite 207 E-Mail: xxx xxx

Dublin, CA 94568