TENTH SCHEDULE
[Subregulation
7(2)]
MONTHLY INDUSTRIAL
EFFLUENT OR MIXED EFFLUENT DISCHARGE MONITORING REPORT
SECTION I
IDENTIFICATION
IDENTIFICATION
1.
(i)
Name and address of premises:
..............................................................................................................................................................
……………………………………………………………………………………………………….
Telephone number: .……………………………………Fax number: ………………………...........
Telephone number: .……………………………………Fax number: ………………………...........
(ii)
File reference number (if applicable): ………...…………………………....................................
2.
(i) Name and address of accredited
analytical laboratory: ..................................................................
Telephone number: ……………………………….Fax
number: ……………..…………………...
(ii)
Name of analyst:
...........................................................................................................................
3. (i) Reporting
year:………………………………………………………………..................................
(ii) Reporting month: …………………………………………………………….................................
SECTION II
INFORMATION ON
INDUSTRIAL EFFLUENT OR MIXED EFFLUENT
4. (i)
Flowrate*
Minimum: ………………………...….……. m3/d,
Maximum: ………………….………….…. m3/d
(ii)
Quality of effluent discharged (unit in mg/L)
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Parameter ***
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First Week
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Second Week
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Third Week
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Fourth
Week
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Sample Date
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Date: …………
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Date: …………
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Date: …………
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Date:
………
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Temperature
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pH Value
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BOD5 at 20°C
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COD
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Suspended Solids
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Mercury
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Cadmium
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Chromium, Hexavalent
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Arsenic
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Cyanide
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Lead
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Chromium,Trivalent
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Copper
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Manganese
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Nickel
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Tin
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Zinc
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Boron
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Iron
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Silver
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Aluminium
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Selenium
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Barium
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Fluoride
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Formaldehyde
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Phenol
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Free Chlorine
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Sulphide
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Oil and Grease (n-hexane
extract)
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Ammoniacal Nitrogen
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Colour**
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* The flowrate and concentration of industrial effluent or mixed effluent at the point of discharge as determined in accordance with the sampling procedure and method of analysis as specified in regulation 16.
** ADMI unit
*** Choose only the significant parameters
SECTION
III
DECLARATION
DECLARATION
I,
………………………………..hereby declare that all information given in this form is to the
best of my knowledge and belief true and correct.
Signature of responsible person:
………………………………….....................……………………. Name: ………………………………................... Designation: ………………………….................
Date : …………………………………................
(Affix official seal or stamp of the company)
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