This government document is issued by Department of Agriculture for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:qqxrx9mf39e&q=https://www.agriculture.pa.gov/consumer_protection/FoodSafety/Laboratory/Documents/Appendix%2520N%2520QC%2520Forms%2520Presentation.pdf&sa=U&ved=2ahUKEwijgvrU_tL8AhXxgf0HHfL-A3E4UBAWegQIABAC&usg=AOvVaw3LcrKEFIe3AOa8TUichHDn