DOC:CB/CL/QR/5.8/IL-3
Issue No.: 04
Revision No. :01
Issue Date : 11.12.2013
Sample Reg. No. : ______________________
CENTRAL POLLUTION CONTROL BOARD
Parivesh Bhawan, East Arjun Nagar, Delhi-110032
INSTRUMENTATION LABORATORY
Requisition for Analysis of Trace Organic Carbons/ Adsorbable Organic Halide Samples
1.
2.
3.
4.
5.
6.
7.
Division
Project
Sampling Source
Sample Matrix
Sample Collected By
Date & Time of sampling
Samples Details
(i)
Sample preservation condition
:
:
:
:
:
:
(ii)
Sample Code no./nos
:__________________________
(iii)
Total No. of samples
:_________________________
(iv)
Parameter to be analysed
: Please tick or encircle
TC
Indentor
TOC
Incharge
(Indenting Division)
:__________________________
DOC
Incharge
(Instrumentation Lab)
TIC
AOX
Incharge
(Sample receiving section)
ACKNOWLEDGEMENT
Received__________Samples
from
No.___________to______on_____at_____a.m./p.m.
from_______________ Division/Zonal Office/SPCB for Physico-chemical/Biological ______ Testing
Remarks :
DOC:CB/CL/QR/5.8/IL-1
Issue No.: 04
Revision No. :01
Issue Date : 11.12.2013
Sample Reg. No. : ______________________
CENTRAL POLLUTION CONTROL BOARD
Parivesh Bhawan, East Arjun Nagar, Delhi-110032
INSTRUMENTATION LABORATORY
Requisition for Analysis of Trace Metals
1.
2.
3.
4.
5.
6.
7.
Division
:
Project
:
Sampling Location
:
Sample Collected by
:
Sample Matrix
: Water/Soil/Sludge
Date & Time of sampling
:
Samples Details
:
(i)
Sample nature
: Grab/ Composite: Preservation
(ii) Sample Pre-treated / Untreated
:__________________________
(iii)
Sample Digested by
:__________________________
(iv) Digested Sample Volume
(15 ml x no.of metals to be analyzed):_________________________
(v) Blank code no./nos
: _________________________
(vi) Sample Code no/nos
:__________________________
(vii) Total No. of Samples
:__________________________
(viii) Metals to be analysed
: Please tick or encircle
As
Cd
Cr
Cu
Fe
Pb
Mn
Hg
Ni
Zn
Sb
Co
Se
V
Any Other Information :
Indentor
Incharge
(Indenting Division)
Incharge
(Instrumentation Lab)
Incharge
(Sample receiving section)
ACKNOWLEDGEMENT
Received__________Samples
from
No.___________to______on_____at_____a.m./p.m.
from_______________ Division/Zonal Office/SPCB for Physico-chemical/Biological ______ Testing
DOC:CB/CL/QR/5.8/IL-1
Issue No.: 04
Revision No. :01
Issue Date : 11.12.2013
Sample Reg. No. : ______________________
CENTRAL POLLUTION CONTROL BOARD
Parivesh Bhawan, East Arjun Nagar, Delhi-110032
INSTRUMENTATION LABORATORY
Requisition for Analysis of Trace Metals
8.
9.
10.
11.
12.
13.
14.
Division
:
Project
:
Sampling Location
:
Sample Collected by
:
Sample Matrix
: Water/Soil/Sludge
Date & Time of sampling
:
Samples Details
:
(ix) Sample nature
: Grab/ Composite: Preservation
(x) Sample Pre-treated / Untreated
:__________________________
(xi) Sample Digested by
:__________________________
(xii) Digested Sample Volume
(15 ml x no.of metals to be analyzed):_________________________
(xiii) Blank code no./nos
: _________________________
(xiv) Sample Code no/nos
:__________________________
(xv) Total No. of Samples
:__________________________
(xvi) Metals to be analysed
: Please tick or encircle
As
Cd
Cr
Cu
Fe
Pb
Mn
Hg
Ni
Zn
Sb
Co
Se
V
Any Other Information :
Indentor
Incharge
(Indenting Division)
Incharge
(Instrumentation Lab)
Incharge
(Sample receiving section)
ACKNOWLEDGEMENT
Received__________Samples
from
No.___________to______on_____at_____a.m./p.m.
from_______________ Division/Zonal Office/SPCB for Physico-chemical/Biological ______ Testing