Recall Log Pure Iceberg Water Inc. Certification #WBF237322

• Pure Iceberg Water Inc.
  1 - 3 Murray's Point Road
  St. Anthony, NL A0K 4S0

• Check here to indicate a Mock Recall

• Enter Date and Time

  Date

• Employee Name Completing This Log

Recalled Raw Ingredients (Initiated by a Supplier)

• Name of Supplier Issuing Recall.

• List Ingredients & Lot #'s, PLU #'s, or Identifier.

• Reason for Supplier Recall.

• What is the Recall Level (per CFIA).

  Select MOCK Level 1 Level 2 Level 3

  • MOCK
  • Level 1
  • Level 2
  • Level 3

• List Quantity(s) of Recalled Product Received.

• List Quantity(s) of Recalled Product On-Hand.

Recalled Finished Goods Recall (Initiated by You)

• List Ingredients & Lot #'s, PLU #'s, or Identifier.

• Reason to Initiate Recall.

• What is the Recall Level (per CFIA).

  Select MOCK Level 1 Level 2 Level 3

  • MOCK
  • Level 1
  • Level 2
  • Level 3

• List Quantity(s) of Product Affected.

• List Quantity(s) of Recalled Product On-Hand.

Communication of Recall

• Recall Team Notified.

  Yes

  No

  N/A

• CFIA Notified.

  Yes

  No

  N/A

• Affected Customers Notified.

  Yes

  No

  N/A

• Press Release Issued.

  Yes

  No

  N/A

Disposition

• Affected Product Segregated.

  Safe

  At Risk

  N/A

• Enter Disposition Plan.

• Employee Name & Signature.

  Sign

• Supervisor Name & Signature.

  Sign