Insert the name of the local authority.

Insert date.

Insert name of person submitting the sample for analysis and mode of transport.

Insert the name or description applied to the material.

Insert the distinguishing mark on the sample and the date of sampling shown.

Indicate the particulars marked, labelled or otherwise documented.

Insert the relevant results, the conclusions drawn from those results and any other relevant observations. Expand this section as necessary.

In the case of analysis of substances for which no method is prescribed by relevant EU legislation, after the results indicate the method used.