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APPENDIX A
FORM I
(See rule 7)
NOTICE OF INTENTION TO HAVE SAMPLE ANALYSED
To
...................................
...................................
Date ...................................
*Specify the place from where the sample is taken.
FORM II
(See rule 8)
MEMORANDUM TO GOVERNMENT ANALYST
From
.........................
.........................
To
The Government Analyst
....................................
....................................
....................................
The portion of sample described below is sent herewith for analysis under rule 6 of the Environment (Protection) Rules, 1986.
The portion of the sample has been marked by me with the following mark:
Details of the portion of samples taken.
Date ...............................
FORM III
(See rule 8)
REPORT BY GOVERNMENT ANALYST
Report No. ..............................
Date ........................................
I hereby certify that I .........................................Government Analyst duly appointed under section 13 of the Environment (Protection) Act, 1986 received on the ......................................day of .......................... 20............................................ from .....................................................
*........................................................................a sample of ............................................for analysis.
The sample was in a condition fit for analysis as reported below.
I further certify that I have analysed the aforementioned sample on .........................and declare that the result of the analysis to be as follows:
**.....................................................................................................................................................................................................................................
The condition of seals, fastening of samples on receipt was as follows:
Signed this .....................................................................day of............................................................................20.......................................................
Address .............................
............................
Signature
(Government Analyst)
To
..........................................
..........................................
..........................................
*Here write the names of the officer/authority from whom sample was obtained.
**Here write full details of analysis and method of analysis.
FORM IV
(See rule 11)
FORM OF NOTICE
By registered post-acknowledgment due
From (1)
Shri................................
.......................................
.......................................
To
.......................................
.......................................
Notice under section 19(b) of the Environment (Protection) Act, 1986
Whereas an offence under the Environment (Protection) Act, 1986 (29 of 1986) has been committed/is being committed by ...........................(2) I/We hereby give notice of 60 days under section 19(b) of Environment (Protection) Act, 1986 (29 of 1986) of my/our intention to file a complaint in the Court against .............................(3) for violation of section.......................of the Environment (Protection) Act, 1986 (29 of 1986).
In support of my/our notice, I am/we are enclosing the following documents (3) as evidence of proof of violation of the Environment (Protection) Act, 1986 (29 of 1986).
Place ...................................
Date .....................................
.................................
Signature(s)
Explanation. - (1) In case the notice is given in the name of a company, documentary evidence authorising the person to sign the notice on behalf of the company shall be enclosed to this notice.
Company for this purpose means a company defined in the Explanation to sub-rule (6) of rule 4.
(2)
Here give the name and address of the alleged offender. In case of a manufacturing/processing/operating unit, indicate the name/location/nature of activity, etc.
(3)
Documentary evidence shall include photographs/technical reports/health reports of the area, etc., for enabling enquiry into the alleged violation/offence.
[FORM V] [Substituted by G.S.R. 386(E), dated 22-4-1993 (w.e.f. 22-4-1993). Earlier it was inserted by G.S.R. 329(E), dated 13-3-1992 (w.e.f. 13-3-1992)]
(See rule 14)
Environmental Statement for the financial year ending the 31st March,.............