| Sample No: | 101136 |
| Report | AlcoholinBlood |
| US | U/S-21 |
| PS | City Thana |
| P.M/M.L | P.M/M.L-21 |
| ACCUSED | NAME OF ACCUSED-21 |
| PHYSICAL EXAMINATION | PHYSICAL EXAMINATION-21 |
| OPINION | |
| DESCRIPTION | |
| PHYSICAL APPEARANCE | |
| GRAMS | |
| Test Performed | |
| G.W.S | |
| N.W.S | |
| ALCOHOL METER | |
| REFRACTO METER |