The State Department of Justice shall provide a common reporting form for the substances in Section 11100 which contains at least the following information:
- (a) Name of the substance.
- (b) Quantity of the substance sold, transferred, or furnished.
- (c) The date the substance was sold, transferred, or furnished.
- (d) The name and address of the person buying or receiving such substance.
- (e) The name and address of the manufacturer, wholesaler, retailer, or other person selling, transferring, or furnishing such substance.