Schedule- 4
(Relating to Clause (a) of Sub-rule (1) of Rule 11)
Sent from:
To,
The … … … … … …
… … … … … …
Number: Date:
Description of the food sent for analysis:
1. Serial number of the sample:
2. 48 …………
3. Date …… 49 of sample collection:
4. Description of the substance sent for test and analysis:
5. Description and quantity of the preservative, if any, added to the sample:
A duplicate copy of this letter and a specimen of the wax seal put on the
sample packet are being sent separately by post or air document or by hand.
… … … … … …
Food Inspector, or
Court or other Authority