Report No………………………..
Dated the…………………………
I hereby certify that I, (I)………………………………………….. Government analyst duly appointed Under subsection 1 of section 27 of the Air (Prevention and Control of Pollution) Act 1981, received on the (II)………………day of ……………. 19………… from (III)…………………..a sample of …………………for analysis. The sample was in a condition fit 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)…………………………………………………………………………………………
...............................………………………………………………………………………
Signed this…………………………….. day of…………………………… 19…………
Address………………………….. (Signature)
....................... (Government Analyst)
To
................................
...............................
________________________________________________________________________
(I) Here write the full name of the Government analyst.
(II) Here write the date of receipt of the simple.
(III) Here write the name of the Board or person or body or persons or office 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, the details may be given on a separate sheet of paper.
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