The Water (Prevention and Control of Pollution) Rules, 1975 - Form XI

Email Print This Page bookmark
Font : A-A+


FORM XI - REPORT BY THE GOVERNMENT ANALYST
(See rule 27)

Report No:
Date:

I hereby certify that 1, (I) ___________ Government analyst duly appointed under sub-section (I) of section 53 of the Water (Prevention and Control of Pollution) Act, 1974 (6 of 1974) received on the (II) ______________ day of _____________ 19__ from (III) a sample of ______________ for analysis. The sample was in a condition for analysis reported below:

I further certify that I have analysed the aforementioned sample, on (IV) ____________ and declare the result of the

analysis to be as follows:-

(V)________________________________

___________________________________

The condition of the seals, fastening and container on receipt was as follows:-

_____________________________________________

_______________________________________ signed this __________ day of __________ 19

(Signature)
(Government analyst)

Address ____________________________

___________________________________

To
_________________________________
_________________________________
_________________________________

(I) Here write the full name of the Government analyst.

(II) Here write the date of receipt of the sample.

(III) Here write the name of the Board or person or body of persons or officer from whom the sample was received.

(IV) Here write the date of analysis.

(V) Here write the details of the analysis and refer to the method of analysis. If the space is not adequate and details may be given on a separate sheet of paper.

Post a Comment

Comments should be on the topic and should not be abusive. The editorial team reserves the right to review and moderate the comments posted on the site.
Notify me when reply is posted
I agree to the terms and conditions
Benefits of Registration

Medindia Newsletters

Subscribe to our Free Newsletters!

Terms & Conditions and Privacy Policy.

Stay Connected

  • Available on the Android Market
  • Available on the App Store