216. The certificate of the person designated by the board stating that he or she has tested a breath sample provided by a person chosen to be tested for his or her blood alcohol level and indicating the results of the test is proof of the facts alleged therein without it being necessary to prove the signature or the official capacity of the signatory, provided that the certificate of that person includes:(1) the name of the person who provided the sample;
(2) the place where the sample was taken and the date and time at which it was taken;
(3) an attestation to the effect that the test of the breath sample was made with a device operated by him or her;
(4) the results of the test.