Section 1974 in The Water (Prevention And Control Of Pollution) Rules, 1975
1974.
) received on the (II) ___________________ day of ___________________ 19__from (III) a sample of ____________________ for analysis. The sample was in acondition for analysis reported below:I further certify that I haveanalysed the aforementioned sample, on (IV) __________________ and declare theresult 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)(Governmentanalyst)Address_______________________________________________________________________________To_________________________________________________________________________________________________________________________________(I)Here write the full name ofthe Government analyst.(II)Here write the date ofreceipt of the sample.(III)Here write the name of the Board or person or body of persons or officer from whom the sample wasreceived.(IV)Here write the date ofanalysis.(V)Here write the details of theanalysis and refer to the method of analysis. If the space is not adequate anddetails may be given on a separate sheet of paper.FORM XIICENTRAL POLLUTION CONTROL BOARDNotice of intention to have sample analysed(See Rule 31)To________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Take notice that it is intendedto have analysed the sample of water/sewage effluent/trade effluent which isbeing taken today the _________day of ___________ 19__ from (1)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Name anddesignation of the personwho takesthe sample(I)Here specify the stream, well, plant, vessel or place from where the sample is taken.To_________________________________________________________________________________________________________________________________
