FORM XII - CENTRAL POLLUTION CONTROL BOARD
Notice of intention to have sample analysed
(See Rule 31)
Take notice that it is intended to have analysed the sample of water/sewage effluent/trade effluent which is being taken today the _________day of ___________ 19__ from (1)
Name and designation of the person
who takes the sample
(I) Here specify the stream, well, plant, vessel or place from where the sample is taken.