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

FORM X - REPORT BY THE CENTRAL BOARD ANALYST
(See Rule 26)

Report No.:
Dated :

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 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)
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.