Form XII
Central Board for Prevention and Control
on Water Pollution
Notice of intention to have sample analysed
(SEE RULE 31)
To..............................................................................................................................
Take notice it is intended to have analysed the sample of water/sewage effluent/trade effluent which a being taken today the…….day of……19…….from
(I).................................................................................................. ........................................................................................................................................................... ....................................................................................................
Name and designation of the person
who takes the sample.
(1) Here specify the stream, well, point, vessel or place from where the sample is taken.
To...........................