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Bare acts > Water (Prevention and Control of Pollution) Rules, 1975 > Form X
 
   


 

FORM X

Report by the Central Board Analyst

See rule 26

Report No _________

Dated the __________ 19__

I hereby certify that I, (I)____________ Central Board Analyst duly appointed under sub-section (3) 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 fit for analysis reported below:

I further certify that I have analysed the aforementioned sample on

(IV) ______________ and declare the result of the analysis is to be as follows:-

(V) _____________________________________ The condition of the seals, fastening and container on receipt was as follows: Signed this ________ day of _________ 19_____

(Signature)

Central Board Analyst

Address ______________

______________________

To

________________

_______________

(I) Here write the full name of the Central Board 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 the details may be given on a separate sheet of paper.

 

 

 

 

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