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Doc no : QF/SGAM/34-A

Rev no : 01
Issue no : 02
Date
: 17.10.2011

FORM 4
FORMAT FOR TESTING FROM OUTSIDE LABORATORY

AS PER STI 14543/7 AUG 2011


w.e.f 15.09.11

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

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