DOC: CB/CL/QR/5.8/BL-1
Issue No.: 03
Revision No:00
Issue Date: 10.12.2013
Sample Reg. No.: _________________________
CENTRAL POLLUTION CONTROL BOARD
Parivesh Bhawan, East Arjun Nagar, Delhi-110 032
BIO-SCIENCE LABORATORY
Requisition for Analysis of Biological samples
1.
Organisation / Institution / Division
:
___________________________________________
2.
Project
:
___________________________________________
3.
Sampling location
:
___________________________________________
4.
Sample/s collected by
:
___________________________________________
5.
Date & time of sampling
:
___________________________________________
6.
Sample details
Sample matrix
:
___________________________________________
(ii) Sample code no./nos.
:
___________________________________________
(iii) Total no. of samples
:
___________________________________________
(iv)
:
___________________________________________
:
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(i)
7.
Sample preservation condition
Report to be sent to
A. Microbiological parameters under NABL scope to be analyzed (√ Mark):
Total Coliform
(MPN/100ml)
Fecal Coliform
(MPN/100 ml)
Fecal Streptococcus
(MPN/100ml)
Enterococcus faecalis
(MPN/100 ml)
Escherichia Coli
(MPN /100ml)
Total Heterotrophic Plate
Count (CFU/ml)
B. Toxicity in terms of Toxicity Factor (TF) under NABL scope to be analyzed.
C.
Bio-monitoring samples of Benthic macro-invertebrates under NABL scope to be analyzed:
Saprobic score
D.
Diversity score
Biological water quality
Biological water quality class
Parameters to be analysed other than NABL scope:
Indentor
In charge
In charge
In charge
Indenting Division
Bio-lab
Sample Receiving Section
---------------------------------------------------------------------------------------------------------------------Sample Reg. No. __________________
ACKNOWLEDGEMENT
Received ____________ samples from No.________________ to __________ on __________ at _________ a.m./p.m. from
_____________________ Division/Zonal Office/SPCB / for Physico-Chemical/Biological/_________________Testing.
Remarks:
Date:
Signature
Sample Receiving Section