When a sample of specially denatured spirits is withdrawn from a dealer's premises, that dealer shall attach a label to the sample which shows the following information:
(a) The word “Sample”;
(b) The dealer's name, address, and permit number;
(c) The words “Specially Denatured Alcohol” or “Specially Denatured Rum”;
(d) The quantity; and
(e) The formula number.