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Advances- (a) Miscellaneous Advances (b) Other amount recoverable. Cash- (a) Notice/Short Term Deposits (b) Cash at Bank (c) Cash in hand (d) Cash in transit Total: ________ ________ Total ______________ ______________ Accounts Officer Member Secretary Chairman The Water (Prevention of Pollution) Rules, 1975 72 The Water (Prevention and Control of Pollution) Rules, 1975 73 FORM VIII CENTRAL POLLUTION CON'TROL BOARD ANNUAL STATEMENT OF ACCOUNT Expenditure on works as on 31st March, 19 (Item l-Assets of the Balance Sheet) (See Rule 25) Sl. No. Name of work Upto 31st March 19 During the year 19 Upto 31st March 19 Direct Expenditure Overhead Charges Total Expenditure Direct Expenditure Overhead Charges Total Expenditure Direct Expenditure Overhead Charges Total Expenditure TOTAL Accounts Officer Member-Secretary Chairman 73 The Water (Prevention of Pollution) Rules, 1975 The Water (Prevention and Control of Pollution) Rules, 1975 74 FORM IX CENTRAL POLLUTION CONTROL BOARD Annual Statement of Accounts Fixed Assets as on 31st March, 19__ (Item 2 Assets of the Balance Sheet) Other Assets as on 31st March, 19__ (Item 3 Assets of the Balance Sheet) (See Rule 25) Sl. No. Particulars of Assets Balance as on 31st March 19 Additions during the years Total Depreciation during the year Sales of write off during the year Balance as on 31st March 19 Cumulative Depreciation as on 31st March 19 Accounts Officer Member-Secretary Chairman The Water (Prevention of Pollution) Rules, 1975 74 The Water (Prevention and Control of Pollution) Rules, 1975 75 FORM X REPORT BY THE CENTRAL BOARD ANALYST (See Rule 26) Report No. _____________ Dated the _______________ 19______ I hereby certify that I, (I)_______________________Central Board analyst duly appointed under sub-section (3) of section 53 of the Water (Prevention and Control of Pollution) Act, 1974 (6 of 1974) received on the (II) ______________ day of ____________ 19__ from (III) ___________ a sample of ________________ for analysis. The sample was in a condition fit for analysis reported below; I further certify that I have analysed the aforementioned sample on (IV) ____________ and declare the result of the analysis reported below; I further certify that I have analysed the aforementioned sample on (IV) _______________ and declare the result of the analysis to be as follows : (V)______________________________________________________________ ________________________________________________________________________ The condition of the seals, fastening and container on receipt was as follows:- ________________________________________________________________________ ________________________________________________________________________ signed this _______________ day of _______________ 19__. (Signature) Central Board analyst. Address_______________________________ ______________________________________ To ______________________________________ ______________________________________ ___________________________________________ (I) Here write the full name of the Central Board-analyst. (II) Here write the date of receipt of the sample. (III) Here write the name of the Board or person or body of persons or officer from whom the sample was received. (IV) Here write the date of analysis. (V) Here write the details of the analysis and refer to the method of analysis. If the space is not adequate the details may be given on a separate sheet of paper. The Water (Prevention and Control of Pollution) Rules, 1975 76 FORM XI REPORT BY THE GOVERNMENT ANALYST (See rule 27) Report No __________________ Dated the __________________19 I hereby certify that 1, (I) ________________________ Government analyst duly appointed under sub-section (I) of section 53 of the Water (Prevention and Control of Pollution) Act, 1974 (6 of 1974) received on the (II) ___________________ day of __________________ 19_______ from (III) a sample of ____________________ for analysis. The sample was in a condition for analysis reported below: I further certify that I have analysed the aforementioned sample, on (IV) __________________ and declare the result of the analysis to be as follows:- (V)______________________________________________________________ ________________________________________________________________________ The condition of the seals, fastening and container on receipt was as follows:- ________________________________________________________________________ ________________________________________________________________________ signed this _____________ day of ___________________ 19 (Signature) (Government analyst) Address ____________________________________ ___________________________________________ To ___________________________________________ ___________________________________________ ___________________________________________ (I) Here write the full name of the Government analyst. (II) Here write the date of receipt of the sample. (III) Here write the name of the Board or person or body of persons or officer from whom the sample was received. (IV) Here write the date of analysis. (V) Here write the details of the analysis and refer to the method of analysis. If the space is not adequate and details may be given on a separate sheet of paper. The Water (Prevention and Control of Pollution) Rules, 1975 77 FORM XII CENTRAL POLLUTION CONTROL BOARD Notice of intention to have sample analysed (See Rule 31) To ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Take notice that it is intended to have analysed the sample of water/sewage effluent/trade effluent which is being taken today the ________________________ day of ___________ 19__ from (1) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Name and designation of the person who takes the sample (I) Here specify the stream, well, plant, vessel or place from where the sample is taken. To ___________________________________________ ___________________________________________ ___________________________________________ The Water (Prevention and Control of Pollution) Rules, 1975 78 1[FORM XIII Application for consent for establishing or taking any steps for establishment of Industry operation process or any treatment disposal system for discharge, continuation of discharge under section 25 or section 26 of the Water (Prevention and Control of Pollution) Act, 1974. (See Rule 32) Date ______________________ From ______________________________ ______________________________ ______________________________ To The Member Secretary, Central Pollution Control Board. Sir, I/We hereby apply for Consent/Renewal of Consent under section 25 of the Water (Prevention and Control of Pollution) Act, 1974 (6 of 1974) for establishing or taking any steps for establishment of Industry/operation process or any treatment/disposal system to bring into use any new/altered outlet for discharge of *sewage/trade effluent* to continue to discharge* sewage/trade effluent* from land/premises owned by____________________. The other relevant details are below:-