Notice of intention to take sample for analysis

To

Sri ………………………..
S/o………………………..
R/o ………………………..

I have this day take from premises of ……………………………………… situated at ……………………….. samples of the food specified below to have the same analysed by the public analyst, for ………………..

Details of food.
…………………………….
…………………………….

Food Inspector,
……………….
Area………………
Place ……………
Date ……………