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Remove BV Logo. Top margin to be
maintained same as Cust Spec Report

ADDRESS OF THE CUSTOMER Issued to
Bureau Veritas India Pvt Ltd - Chennai
F2, Thiru, Vi. Ka. Industrial Estate,
Phase III, Ekkattuthangal, Guindy
: Bureau Veritas India Pvt Ltd - Chennai
F2, Thiru, Vi. Ka. Industrial Estate,
Page Nos.
Phase III, Ekkattuthangal, Guindy

TEST REPORT AS PER “STANDARD” (to be mapped with “Standard” Field)

TEST REPORT AS PER : To be Mapped with “Standard”Field
ULRNo:
ULR No:Mapped
ULR No. Report
with ULR Number:
No. Report Number Group:
Standard Group Discipline: Discipline
Correct Dated :10-06-2019

Internal Sample Number: BV Sample ID Date: Report issue date

PART A. PARTICULARS OF SAMPLE SUBMITTED (Centre)
a) Sample Nature of Description : Sample Name - Correct
FSSAI – Correct. Field name to change to
b) Grade/Variety/Type/Class/Size etc :
Grade/Variety/..to maintain uniformity
c) Brand name, if any : Brand Name - Correct

d) Declared values, if any : Input field to be mapped

BV/CHEN/19/05/1220-001 Sample ID given by customer.
e) Sample Code No. :
Feld mapping needed
f) Batch No. & Control Unit No Date of Manufacture : Batch Number / 30/05/2019 Correct

Field to be mapped. Separate Qty field will be

g) Quantity :
needed
h) Nature Mode of Packing : Mode of packing Correct

i) Date of Receipt : 17/05/2019 (Receipt date)

INTACT / NOT INTACT / NOT SEALED WAX SEALED
j) BIS Seal :
---------------DISPLAY FORMAT------ <-TEXT INPUT>
k) IO’s Signature : Signed / Unsigned
l) Any other information : Map with “other information”

m) Date of commencement of testing : Test Assignment Date

n) Date of completion of testing : Last test result approved date

NOTES
1. This report, in full or in part, shall not be published, advertised, used for any legal action, unless prior
permission has been secured from the Director General, Bureau of Indian Standards. This report is intended
for " BIS CERTIFICATION MARKS PURPOSE ONLY “

2. This test report is ONLY FOR THE SAMPLE TESTED.

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PART B. SUPPLEMENTARY INFORMATIONS (Centre, Part B to start on new page)

ULR No: Mapped with ULR Number Standard Correct Dated :10-06-2019
REPORT NO:BV/CHEN/19/05/1220

a) Reference to sampling procedure, wherever applicable : Sampling Procedure Correct

b) Supporting documents for the measurements taken : Field to be mapped

and results derived like graphs, tables, sketches and/or
Photographs as appropriate to test report, if any [ To be
attached ]

c) Deviation from the test methods as prescribed in : Field to be mapped

Relevant ISS/Work Instructions, if any :
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PART C. TEST RESULTS (Centre, should start from new page)

ULR No: ULR No. Date: Report issue date

Report Number: Report Number Internal Sample Number: BV Sample ID

Fixed header on every page

NO BLANK SPACE. Result table should from this page.

SEQUENCE OF TABLES –

MICROBIOLOGY

TABLE 1

TABLE 2

TABLE 3

ANNEX D

PART D - Remarks
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CL. TEST METHOD FOLLOWED

SL. No. TESTS PARAMETERS RESULTS
REF. SPECIFIED REQUIREMENT
Microbiology Test BIS
1 Escherichia coli (e.coli- 5.1.1 IS 15185:2002, RA 2009
thermotolerant Bacterant coliform
Bacteria
2 Total Coliform bacteria 5.1.2 IS 15185:2002, RA 2009

3 Staphylococcus aureus 5.2.3 IS 5887-Part 2 - 1976 RA 2013 10

4 Faecal streptococci 5.1.3 IS 15186 : 2002-RA 2014 10.00

5 Sulphite Reducing Bacteria 5.2.4 Annec C of IS:13428 10

6 Pseudomonas Aeruginosa 5.2.5 Annex D of IS 13428 Absent

7 Aerobic Microbial Count

a Total viable/ml at 20 to 220c in IS 15815:2002 RA 2009 10.00
72hrs
b Total Viable Colony Count per ml IS 15815:2002 RA 2009 10
at 37 Deg C in 24 hrs
8 Yeast & Mould IS 5403:1999, RA 2009 120

9 Salmonella IS 15187:2002, RA 2009 #CONV_ERROR

10 Shigella 5.1.8 IS 5887 Part7:1999, Absent

11 Vibrio cholerae IS 5887 Part 5:1976 10.00

12 Vibrio parahaemolyticus IS 5887 Part 5:1976 #CONV_ERROR

TEST METHOD FOLLOWED

SL. No. TESTS PARAMETERS RESULTS
SPECIFIED REQUIREMENT
TABLE NO: 01 Organoleptic and Physical Parameters (Clause 5.2)
Merge into 1 row
Organoleptic and Physical Parameters (Clause 5.2) delete row
1 Colour IS 3025 (P-4): 1983 10
2 Odour IS: 3025 Part.5 1983 RA 2012 0
3 Taste IS: 3025 Part.8 1984 RA 2012 0
4 Turbidity (NTU) IS: 3025 Part.10 1984 RA 2017 10
5 Total dissolved solids IS 3025 Part 16: 1986 10
6 pH IS: 3025 Part.11 1983 RA 2017 11
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SL. No. TESTS PARAMETERS TEST METHOD FOLLOWED RESULTS

TABLE NO: 02 General Parameters (Clause 5.2)

General Parameters (Clause 5.2) delete row
1 Barium (as Ba) IS 3025 (P.65): 2014 12.0
2 Copper as Cu IS 3025 (P.65): 2014 13.000
3 Iron as Fe IS 3025 (P.65): 2014 14.000
4 Manganese as Mn IS 3025 (P.65): 2014 15.000
5 Nitrate as NO3 IS 3025 (P-34): 1988 20
6 Fluorides as F IS 3025 (Part.60):2008 RA 2013 18
7 Zinc as Zn IS 3025 (P.65): 2014 19.000
8 Silver as Ag IS 3025 (P.65): 2014 20.00
9 Aluminium as Al IS 3025 (P.65): 2014 21
10 Chlorides as Cl IS 3025 (Part.32):1988 RA 2014 0
11 Selenium as Se IS 3025 (P.65): 2014 23.00
12 Sulphate as SO4 IS 3025 (Part.24):1986 RA 2014 24
13 Alkalinity IS 3025 (Part.23):1986 RA 2014 25
14 Calcium as Ca IS 3025 (P-40): 1991 30
15 Magnesium IS 3025 (P-46): 1994 27
16 Sodium as Na IS 3025 (Part.2): 2004 RA 2014 28.0
17 Residual free chlorine IS 3025 (P-26): 1986 29
18 Phenolic compounds AS C6H50H IS 3025 Part 43 - 1992 RA 2009 30
19 Mineral oil Cl.6 of IS 3025 Part 39:1991 31
20 Anionic surface active agent APHA 23rd Ed. 2120 B 32
21 Sulphide as H2S IS: 3025 Part.29:1986 RA 2009 33
22 Antimony IS 3025 (P.65): 2014 34.000
23 Borates as B IS 3025 (P.65): 2014 35.000
24 Bromate as BRO3 EN ISO 15061 36.000

SL. No. TEST PARAMETERS TEST METHOD FOLLOWED RESULTS

TABLE NO: 03 Toxic Substances (Clause 5.2)

Toxic Substances (Clause 5.2) delete row
1 Mercury as Hg IS 3025 Part 48:1994 55.000
2 Cadmium as Cd IS 3025 (P.65): 2014 56.000
3 Arsenic as As IS 3025 (P.65): 2014 57.000
4 Cyanide as CN IS 3025 Part 27 58
5 Lead as Pb IS 3025 (P.65): 2014 59.000
6 Chromium as Cr IS 3025 (P.65): 2014 60.000
7 Nickel as Ni IS 3025 (P.65): 2014 61.000
8 PAH APHA 22nd ed 6440/ US EPA 63.0
525.2
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SL. No. TEST PARAMETERS TEST METHOD FOLLOWED RESULTS

TABLE NO: ANNEX D Pesticide Residues (Clause 5.3 and 5.3.1)

Pesticide Residues (Clause 5.3 and 5.3.1) delete row
1 DDT (Total) Method R 10 A by GCMS 37.00
2 γ - HCH (Lindane) USEPA 508 38.00
3 δ - HCH USEPA 508 39.000
4 Endosulphan Sulphate USEPA 508 40.000
5 Monochrotophos USEPA 8141A 41.000
6 Ethion USEPA 1657A 42.000
7 Chlorpyriphos USEPA 8141A 43.00
8 Phorate USEPA 8141A 44.000
9 2,4-Dichlorophenoxyacetic acid USEPA 515.1 45.000
10 Butachlor USEPA 8141A 46.000
11 Isoproturon USEPA 532 47.000
12 Alachlor USEPA 525.2 48.00
13 Atrazine USEPA 8141A 49.00
14 Methyl Parathion USEPA 8141A 50.000
15 Methyl Paraoxon USEPA 8141A 51.000
16 Malathion USEPA 8141A 52.000
17 Total Pesticides USEPA 525.2 53.0
18 Aldrin, dieldrin R-02A by GC MS/MS 54.0

Tabular form to be removed

PART D - Mapped with Remarks in COA

Authorized Signatory