When a sample of specially denatured spirits is withdrawn from a dealer's premises, that dealer shall attach a label to the sample which shows the following information: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.