जन स्वास्थ्य अभियांत्रिकी विभाग, हरियाणाPublic Health Engineering Department, Haryana

Request for Water Sample Test

PHED Consumer ID
(optional)
Applicant Name*
MobileNo *
Address *
Email*
Town/village*
District*
Block*
Ward/Village *
Sample Location
Location Latitute *
Location Longitute *
Sample Type *
Test Type *
Category of Sample *
Note : If Category of Sample is not correct as per your request, Request will be rejected, So Select Carefully!
Parameter*
Laboratory(Type)*
Detail of Laboratory(Chemist)
Collected By Name(Who Will Collect Sample from Site)*
Remarks *
Enter Text
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