The undersigned certifies under penalty of perjury that:
1. He performed a test on the (substance) (object) in question;
2. The person from whom he received the (substance) (object) in question is ______________;
3. The document on which this certificate appears or to which it is attached is a true and complete copy of my official report; and
4. Such document is a report of the results of a test which report and test were made by the undersigned who has the following qualifications and experience:
___________________________________________________________.
___________________________________________________________.
___________________________________
Signature
___________________________________
Title
___________________________________
Business Address and Telephone
Amended Effective December 26, 2000.
Wash. Sup. Ct. Crim. R. 6.13