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)
Parameter *** | First Week | Second Week | Third Week | Fourth Week |
Sample Date | Date: ………… | Date: ………… | Date: ………… | Date: ……… |
Temperature | ||||
pH Value | ||||
BOD5 at 20°C | ||||
COD | ||||
Suspended Solids | ||||
Mercury | ||||
Cadmium | ||||
Chromium, Hexavalent | ||||
Arsenic | ||||
Cyanide | ||||
Lead | ||||
Chromium,Trivalent | ||||
Copper | ||||
Manganese | ||||
Nickel | ||||
Tin | ||||
Zinc | ||||
Boron | ||||
Iron | ||||
Silver | ||||
Aluminium | ||||
Selenium | ||||
Barium | ||||
Fluoride | ||||
Formaldehyde | ||||
Phenol | ||||
Free Chlorine | ||||
Sulphide | ||||
Oil and Grease (n-hexane extract) | ||||
Ammoniacal Nitrogen | ||||
Colour** |
* 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)