Shannon’s Imperial Brand
PO BOX 2945
Dublin, CA. 94568-0945
Phone: 925-223-8171
Fax:
925-223-8173
Email: [email protected]
Web: www.shannonsimperial.com
March 2, 2017
Shannon's Imperial
SB-70155 Bear Paw, apple cinnamon
Packed 36 I/W per case
I certify that each Shannon’s Bear Paw, apple
cinnamon contains no less than 32 grams of
creditable grain with no less than 16 grams of
whole grain flour, which equals a 2 grain serving.
32 grams / 16 grams = 2 e.g.
Dale F. Bowman
Owner
Ingredients:
Whole Wheat Flour, Apple Filling (Apples, Water, Sugar, Modified Corn Starch, Lemon Juice, Cinnamon, Citric Acid, Potassium
Sorbate, Gellan Gum, Salt, Nutmeg), Water, Enriched Wheat Flour (Wheat Flour, Malted Barley Flour, Niacin, Reduced Iron,
Thiamine Mononitrate, Riboflavin, Folic Acid), Sugar, Shortening (High Oleic Canola Oil, Hydrogenated Cottonseed Oil Mono- And
Diglycerides, Polysorbate 60), Sweet Potato, Eggs, Dextrose, Contains 2% Or Less Of: Yeast, Soy Flour, Potato Flour, Whey, Nonfat
Milk, Sodium Bicarbonate, Sodium Acid Pyrophosphate, Soy Lecithin, Xanthan Gum, Cellulose Gum, Tocopherols, Ascorbic Acid,
Citric Acid, Corn Starch, Vital Wheat Gluten, Soybean Oil Fermented Wheat Flour, Cultured Corn Syrup Solids, Natural Flavors,
Agar, Guar Gum, Hydrogenated Palm Kernel Oil Corn Syrup, Sunflower Oil Beta-Carotene.
Contains Wheat, Eggs, Soy, Milk.
Formulation Statement for Documenting Grains in School Meals
(Crediting Standards Based on Grams of Creditable Grains)
School Food Authorities (SFAs) should include a copy of the label from the purchased product package in
addition to the following information on the letterhead signed by an official company representative.
SFAs have the option to choose the crediting method that best fits the specific needs of the menu
planner.
Product Name: Bear Paw, apple cinnamon
Code No.: 70155
Manufacturer: Shannon's Imperial Brand
Serving Size:__85 grams / 3 oz.
I.
Does the product meet the Whole Grains-Rich Criteria: Yes__X__ No____
II.
Does the product contain non-creditable grains: Yes_X _ No____ How many grams: _1.11_
III.
Use Policy Memorandum SP 30-2012 Grain Requirements for the National School Lunch
Program and School Breakfast Program: Exhibit A to determine if the product fits into
Groups Q-G (baked goods), Group H (cereal grains) or Group I (RTE breakfast cereals).
(Different methodologies are applied to calculate servings of grain component based on
creditable grains. Groups A-G use the standards of 16 grams creditable grain per oz eq;
Group H uses the standard or 28 grams creditable grain per oz eq; and Group I is reported by
volume or weight.)
Indicate to which Exhibit A Group (A-I) the Product Belongs: ___E_____
Description of Creditable
Grain Ingredient
Whole Wheat Flour
Enriched Flour
Grams of
Creditable Grain
Ingredient per
Portion A
19.5 grams
12.82 grams
32.32 grams
Gram Standard of
creditable Grain per oz
equivalent (16g or 28g) B
16 grams/oz Eq grain
16 grams/oz Eq grain
Creditable
Amount A/B
1.22 Eq Grain
.80 Eq Grain
2.02 Eq Grain
2 Eq Grain
Total Creditable Amount
Total Weight (per portion) of product as purchased___85 grams___
Total contribution of product (per portion) _2.0_ oz. equivalent
I certify that the above information is true and correct and that a 3 gram portion of this product (ready
for serving) provided 2 equivalent Grains. I further certify that non-creditable grains are not above 0.25
oz eq. per portion. Products with more than 0.24 oz. equivalent or 3.99 grams for Groups A-G or 6.99
grams for Group H of non-creditable grains may not credit towards the grain requirements for school
meals.
Owner
Signature
Title
Dale F. Bowman
3/2/17
Printed Name
Date
925-223-8171
Phone Number