REPORT OF INSECTICIDE ANALYST
1. Name of the insecticide inspector from whom received:
2. Serial No. and date of Insecticide Inspector's Memorandum:
3. Number of sample:
4. Date of receipt:
5. Name of the insecticide purporting to be contained in the sample:
6. Condition of the sales on the package:
7. Result of test or an analysis with protocols of test applied:
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