C: CB/CL/QR R/5.8/BL-1 DOC Issue No.: N 03 R Revision No:000 Issue Date: D 10.12.20013 Sample Reg. R No.: ____________________________ CENTRAL PO C OLLUTION CONTROL BO OARD ParriveshBhawan n, East Arjun Nagar, N Delhi-110 032 BIO-SC CIENCE LABORATORY R Requisition foor Analysis of Biological B sam mples 1. Orgganisation / Insstitution / Divission : ______________________________________________ 2. oject Proj : ______________________________________________ 3. mpling location n Sam : ______________________________________________ 4. mple/s collected d by Sam : ______________________________________________ 5. Datte & time of saampling : ______________________________________________ 6. mple details Sam Sample matrrix : ______________________________________________ (ii) Sample codee no./nos. : ______________________________________________ (iii)) Total no. of samples : ______________________________________________ (iv)) : ______________________________________________ : ---------------------------------------------------------------------- (i) 7. Sample preservation p coondition Repport to be sent to t A. Microbiologiical parameters under NAB BL scope to bee analyzed(√ Mark): M Total Colifform (MPN/1000ml) Fecaal Coliform (MP PN/100 ml) Fecal Streptococcuus F (MPN/100ml) Enteroccoccus faecalis(MP PN/100 ml) Escherichia Coli E ( (MPN /100ml) Total Heterotropphic Plate Count (CFU U/ml) L scope to be analyzed. a B. Toxicity in teerms of Toxiciity Factor (TF)under NABL C. Bio-monitorring samples of o Benthic maccro-invertebraatesunder NA ABL scope to be analyzed: Saprobic scorre D. Diverssity score Biological waater quality Biological water quality cllass Parameters to be analysed d other than NABL N scope: In charge In charge In n charge D n Indenting Division Bio-laabSample Receeiving Section --------------------------------------------------------------------------------------------------------------------------Indentor Sam mple Reg. No. ____________________ ACK KNOWLEDG GEMENT _____ samples from m No._________________ to ___________ on ___________ at __________ a.m./p.m. from Reeceived ________ ______________________ Diviision/Zonal Office/SPCB / for Physico-Chemical/Biological/__________________Testing.. Remarks: Date: Signature S Saample Receiving Section CENTRAL POLLUTION CONTROL BOARD Parivesh Bhawan, East Arjun Nagar, Delhi-110032 BIO-SCIENCE LABORATORY Bio-Monitoring Analysis Report (Analysis of Benthic Macro –invertebrates) 1. Report no. & issue date : 2. Date & time of sample collection : 3. Sample collected by : 4. Date of analysis : 5. Samples registration no. & date : 6. Environmental conditions during sampling : 7. Test method reference : Indo-Dutch Method APHA, 10500-A, 10-67 to10-83,22nd Ed, 2012 8. Study duration : 9. Protocol file and biological data register code 10. Report sent to (Name& Address) S. NO Sampling location Field protocol No : : Sample receiving section Analysis Results Saprobic Diversity B.W Score Score Quality B.W.Q Class Indicator Colour 1. Statement: 1. The results relate only to the samples tested. 2. The report shall not be reproduced except in full, without the written approval of the laboratory Analyst DOC:CB/CL/QR/5.10/BL-3 Supervisor Issue No:04 Revision No:01 I/c Bio lab (Authorized Signatory) Issue Date:22.05.2007 Amendment Date:27.03.2014 Page:01 of 01