124x Filetype DOCX File size 0.23 MB Source: detoxgroup.in
SAURASHTRA ENVIRO PROJECTS PRIVATE LIMITED Corporate Office: Detox House, Opp. Gujarat Samachar Press, Udhna Darwaja, Ring Road, Surat. Contact Nos. : 0261 – 2351248, 2346181, 6542020; E-mail: info@sepplindia.com Sample Submission Form Name of the Company Address (Complete postal address with Pin Code) Name: Contact person details Designation: Department: Contact Details Mobile: E-mail Address: Please Attach List of Raw materials used in the Process Safety Measures for handling waste (use of masks, hand gloves, safety goggles etc) Physical State of Waste (“Mark” the relevant) Type of Waste II (“Mark” the relevant) o Solid o Liquid o ETP Sludge o Liquid Waste o Semi-solid o Slurry o Process Residue o Other_______________ Details of Waste as per CCA Name: Category: Date & Time of sample collection Date: Time: Sample location or sample code Location: Code: Quantity of sample required Solid sample: 250 Gms (max.) Liquid sample: 1.0 Litre (max.) Mode of submission Terms & Conditions: Sample Submission Form & Fees shall be different for each sample. Sample Submission Form to be submitted along with Sample is a mandatory requirement. Sample submitted with any incomplete / misleading information shall not be accepted. FOR SEPPL OFFICE USE ONLY Date of receipt of Sample Sale Order No. Sample Received By Sample Submitted to Lab on F/MKT/15/01 01.06.2015
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