C.

L Details for the Year 20 (1st January to 31st December)

Name of the Employee:
Total number of C.L taken during the
Name of the Month C.L(15 Days) current month Balace number of C.L Signature of Office Head
January
February
March
April
May
June
July
August
September
October
November
December

C.L Details for the Year 20 (1st January to 31st December)

Name of the Employee:
Total number of C.L taken during the
Name of the Month C.L(15 Days) current month Balace number of C.L Signature of Office Head
January
February
March
April
May
June
July
August
September
October
November
December
 WATER TESTING REPORT FOR THE MO

Sl. No. Consumer Name Consumer No. Adresss of Consumer

WATER TESTING REPORT FOR THE MONTH:- OF 202 - 202

Free H2S Test for

Dt. Of Collection Residual Bacteria(-ve/+v
Ward No. Mobile No. of Sample Chlorine e) Signature of Consumer
Signature of Jalasathi Remarks
 OFFICE OF THE JUNIOR ENGINEER P.H SECTION, NABARANGPUR

CNSUMER NO:- CONSUMER No:- DOM/COM/INST/IND BILL NO: MONTH & YEAR :-

BILL NO:- NAME:- ISSUED ON:- PAY BY DATE:-

METERED UNMETERED
MONTH & YEAR ADDRESS:- CURR. PREV. UNITS SUMP/OVERHEAD TANK/TAP Nos :
WATER CHARGES :
AMOUNT PAYABLE TOTAL PAYABLE AMOUNT :
A PREVIOUS DUES : ON OR BEFORE PAY BY DATE AFTER PAY BY DATE
B CURRENT DEMAND(W) :
C SEWERAGE FEE :
D OTHER CHARGES :
E CURRENT PAYMENTS :
F

SIGN & DATE AUTHORISED SIGNATORY

Please vist us at:-New PHD Office,Gadia Street,Nabarangpur
Register Complaints on:-New PHD Office,Gadia Street,Nabarangpur

FOR WATER TAX COLLECTIONS

Name of Jalasathi Ward No. Mobile No.
B.Rajani 01,02,03,04,05 7682080788
6370502559
Sunita Naik 06,07,08,09,10 7077434309
Jyotipriya Takri 12,13,14,15 8763102141
Amita Dhanpal 11,16,17 9078848995

06858222454
Offife Contact No:-
9348293038
NO.
Sl. No. Date Particulars of Journey From To
 LOG BOOK FOR THE MONTH:- OF 202 - 202
Odo Meter Reading Fuel Details
Distance Officer using Opening
Intial Reading Final Reading Travelled(Km) Vehicle Purpose of Journey Balance Received
 Fuel Details
Closing Other
Total Consumption Balance Consumables Signature of Driver Signature of Officer
Sl. No. Date Name of the Visitor Mobile No.
Address Purpose of Visit Signature Remark
 Water Testing Register
Location of Sample Testing Parameters
Sl. No. Date Collected P.H Turbidity H2S FRC
Signature of
Technician Remarks
 WATER CONSUMPTION LEDGER OF PUBLIC HEALTH SUB-DIVISION , NABARANGP
FINANCIAL YEAR 202 -202
Name of Consumer :-
Consumer No:-
House No:-
Name of Locality :-
Mater Rent:- B.F Form Ledger No. & Page No:-
Ward No:- Carried Over to Ledger No. & Page No:-

Revenue
Rate per outstandi
Thousand ng from
litters/Gal Previous
Months Start At Finish Advance lons Amount month Mics Total
 LTH SUB-DIVISION , NABARANGPUR
02 -202
Meter No:-
(In Red ink)

Date of Connection:-
Ledger No. & Page No:-
ver to Ledger No. & Page No:-

Receipt Initial of
No. P.W.D Amount the
Form No. Balance to collecting Initial of
III Date Amount be realised Officer the S.D.O Remarks
 CHEMICAL CONSUMPTION
ITEMS ALUM PAC BLEACHING
Date STOCK CONSUMPTION BALANCE STOCK CONSUMPTION BALANCE STOCK
L CONSUMPTION
BLEACHING LIME
CONSUMPTION BALANCE STOCK CONSUMPTION BALANCE REMARK
 LOG BOOK
Name of the Location where motor installed________________________________________________Name of Section_____
For the Month of _______________________________________

Voltmeter Pressure Stopper

Reader Ampere Reader Gauge Reading Time
Date Starting Time R Y B
OG BOOK
_________Name of Section____________________________________Name of Sub-Division
_______________________________

Total Utilised of Spares &

Hours Consumables Signature of Pump Driver Remark