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Doc no : QF/SGAM/34-A

Rev no : 02
Issue no : 02
Date
: 27.04.2016

FORM 4
FORMAT FOR TESTING FROM OUTSIDE LABORATORY

AS PER STI 14543/8 JAN 2016


W.E.F. 01.05.2016

SREE GAYATHRI AQUA


MINERALS
D-205, 206,GOKUL NAGAR,
RAYAKOTTAI ROAD,
HOSUR-635 109.

Month and Year

Batch
Number/Date of
manufacturing

Type of packing

Dates on which
sample sent

Lab to which
sample sent

Test report
number and date

Results

Remarks

A) REPORT FOR MONTHLY TESTS


1. Faecal streptococci and S.Aureus, Salmonella and Shigella, V.Cholera and V.Parahaemolyticus.
2. Mineral Oil, Phenolic Compounds, Antimony, Borate.
B) REPORT FOR SIX MONTHLY TESTS
1. Mercury, Cadmium, Arsenic, Cyanide, Lead, Chromium, Nickel, Fluoride, Selenium, Sodium, PCB, PAH, Bromate.
2. Silver (as applicable)
3. Pesticide Residues.(Initially Six monthly once after no failure found can be done Yearly Once)
C) REPORT FOR TWO YEARLY TESTS
1. Radio Active Residues (Alpha and Beta Emitters)

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