Ãîëîâíà ñòîð³íêà á³çíåñ-ïîðòàëó "Ëåîíîðì"

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Ïðîïîíóºìî Âàì çàìîâëÿòè Îô³ö³éí³ êîﳿ ÍÄ â åëåêòðîííîìó âèãëÿä³ çà äîïîìîãîþ ³íôîðìàö³éíî¿ ñèñòåìè  "ËÅÎÍÎÐÌ-²íôîðì", àáî â ìàãàçèí³ ó íàñ íà ñàéò³, àáî ëèñòîì íà E-mail: mark@leonorm.lviv.ua ...

ÊÎÍÒÀÊÒÈ ÍÎÂÈÍÈ ÐŪÑÒÐÀÖ²ß ÌÀÃÀÇÈÍ ÍÎÐÌÀÒÈÂͲ ÀÊÒÈ ÏÎØÓÊ (RUS)
 

̲ͲÑÒÅÐÑÒÂÎ ÅÊÎËÎò¯ ÒÀ ÏÐÈÐÎÄÍÈÕ ÐÅÑÓÐѲ ÓÊÐÀ¯ÍÈ

ÍÀÊÀÇ

19.04.2013

ì. Êè¿â

N 179

Çàðåºñòðîâàíî â ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè
15 òðàâíÿ 2013 ð. çà N 739/23271

Ïðî çàïðîâàäæåííÿ ôîðì äîêóìåíòàö³¿ ï³äðîçä³ë³â ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ Äåðæåêî³íñïåêö³¿ Óêðà¿íè òà ¿¿ òåðèòîð³àëüíèõ îðãàí³â

³äïîâ³äíî äî Ïîëîæåííÿ ïðî Äåðæàâíó åêîëîã³÷íó ³íñïåêö³þ Óêðà¿íè, çàòâåðäæåíîãî Óêàçîì Ïðåçèäåíòà Óêðà¿íè â³ä 13 êâ³òíÿ 2011 ðîêó N 454/2011, òà ç ìåòîþ óí³ô³êóâàííÿ äîêóìåíòàö³¿ ï³äðîçä³ë³â ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ Äåðæàâíî¿ åêîëîã³÷íî¿ ³íñïåêö³¿ Óêðà¿íè òà ¿¿ òåðèòîð³àëüíèõ îðãàí³â

ÍÀÊÀÇÓÞ:

1. Çàòâåðäèòè ôîðìè äîêóìåíòàö³¿ ï³äðîçä³ë³â ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ, ùî äîäàþòüñÿ:

1.1. Ïðîòîêîë âèì³ðþâàíü âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë (äîäàòîê 1).

1.2. Àêò â³äáîðó ïðîá îðãàí³çîâàíèõ âèêèä³â ñòàö³îíàðíèõ äæåðåë (äîäàòîê 2).

1.3. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó (ïðè âèêîðèñòàíí³ ì³êðîìàíîìåòðà ³ âèì³ðþâàíü òèñêó â êÏà) (äîäàòîê 3).

1.4. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó (ïðè âèêîðèñòàíí³ ì³êðîìàíîìåòðà ³ âèì³ðþâàíü òèñêó â ìì ðò. ñò.) (äîäàòîê 4).

1.5. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó (ïðè âèêîðèñòàíí³ âèì³ðþâà÷à øâèäêîñò³ ³ âèì³ðþâàíü òèñêó â êÏà) (äîäàòîê 5).

1.6. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó (ïðè âèêîðèñòàíí³ âèì³ðþâà÷à øâèäêîñò³ ³ âèì³ðþâàíü òèñêó â ìì ðò. ñò.) (äîäàòîê 6).

1.7. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ðîçðàõóíîê âèòðàòè ãàçó ïðè â³äáîð³ ïðîá ðå÷îâèí ó âèãëÿä³ ñóñïåíäîâàíèõ òâåðäèõ ÷àñòèíîê (ïðè âèì³ðþâàíí³ òèñêó â êÏà) (äîäàòîê 7).

1.8. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ðîçðàõóíîê âèòðàòè ãàçó ïðè â³äáîð³ ïðîá ðå÷îâèí ó âèãëÿä³ ñóñïåíäîâàíèõ òâåðäèõ ÷àñòèíîê (ïðè ñòàíäàðòíîìó çíà÷åíí³ ãóñòèíè ãàçó ³ âèì³ðþâàíí³ òèñêó â êÏà) (äîäàòîê 8).

1.9. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ðîçðàõóíîê âèòðàòè ãàçó ïðè â³äáîð³ ïðîá ðå÷îâèí ó âèãëÿä³ ñóñïåíäîâàíèõ òâåðäèõ ÷àñòèíîê (ïðè ñòàíäàðòíîìó çíà÷åíí³ ãóñòèíè ãàçó ³ âèì³ðþâàíí³ òèñêó â ìì ðò. ñò.) (äîäàòîê 9).

1.10. Äîäàòîê äî Àêòà â³äáîðó ïðîá. Ïðîòîêîë âèì³ðþâàíü âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë ïàëèâîâèêîðèñòîâóþ÷îãî îáëàäíàííÿ (äîäàòîê 10).

1.11. Ïðîòîêîë âèì³ðþâàíü âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë ïàëèâîâèêîðèñòîâóþ÷îãî îáëàäíàííÿ (äîäàòîê 11).

1.12. Ïðîòîêîë âèì³ðþâàíü âì³ñòó åêîëîã³÷íèõ ïîêàçíèê³â íàôòîïðîäóêò³â (äîäàòîê 12).

1.13. Ïðîòîêîë âèì³ðþâàíü ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé âîä (äîäàòîê 13).

1.14. Ïðîòîêîë âèçíà÷åííÿ ãîñòðî¿ òîêñè÷íîñò³ âîä (äîäàòîê 14).

1.15. Ïðîòîêîë âèçíà÷åííÿ õðîí³÷íî¿ òîêñè÷íîñò³ âîä (äîäàòîê 15).

1.16. Àêò â³äáîðó ïðîá âîä (äîäàòîê 16).

1.17. Ïðîòîêîë âèì³ðþâàíü ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé ´ðóíò³â (äîäàòîê 17).

1.18. Ïðîòîêîë âèì³ðþâàíü ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé â³äõîä³â (äîäàòîê 18).

1.19. Àêò â³äáîðó ïðîá ´ðóíò³â (äîäàòîê 19).

1.20. Àêò â³äáîðó ïðîá â³äõîä³â (äîäàòîê 20).

2. Äåðæàâí³é åêîëîã³÷í³é ³íñïåêö³¿ Óêðà¿íè (Æèëà Ï. Á.) çàáåçïå÷èòè ïîäàííÿ öüîãî íàêàçó íà äåðæàâíó ðåºñòðàö³þ äî ̳í³ñòåðñòâà þñòèö³¿ Óêðà¿íè â óñòàíîâëåíîìó çàêîíîäàâñòâîì ïîðÿäêó.

3. Öåé íàêàç íàáèðຠ÷èííîñò³ ç äíÿ éîãî îô³ö³éíîãî îïóáë³êóâàííÿ.

4. Êîíòðîëü çà âèêîíàííÿì öüîãî íàêàçó ïîêëàñòè íà çàñòóïíèêà ̳í³ñòðà - êåð³âíèêà àïàðàòó Ìîðìóëÿ Ä. Ä.

 

̳í³ñòð

Î. À. Ïðîñêóðÿêîâ

ÏÎÃÎÄÆÅÍÎ:

 

Ãîëîâà Äåðæàâíî¿ ñëóæáè Óêðà¿íè
ç ïèòàíü ðåãóëÿòîðíî¿ ïîë³òèêè
òà ðîçâèòêó ï³äïðèºìíèöòâà

Ì. Þ. Áðîäñüêèé

Ãîëîâà Äåðæàâíî¿
åêîëîã³÷íî¿ ³íñïåêö³¿ Óêðà¿íè

Ï. Á. Æèëà

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N _______
âèì³ðþâàíü âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë

â³ä "___" ____________ ____ ð.

³äïîâ³äíî äî Àêòà â³äáîðó ïðîá îðãàí³çîâàíèõ âèêèä³â ñòàö³îíàðíèõ äæåðåë

â³ä ____________ N _________ _________________________________________________________,
                                                                                   (íàéìåíóâàííÿ ï³äðîçä³ëó ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ)
àòåñòîâàíèì íà ïðàâî âèêîíàííÿ âèì³ðþâàíü (Ñâ³äîöòâî ïðî àòåñòàö³þ N _____ â³ä ____________,
âèäàíå ______________________________________________________________________________),
                                                                                            (íàéìåíóâàííÿ îðãàíó ç àòåñòàö³¿)
ïðîâåäåíî âèì³ðþâàííÿ âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí (ÇÐ) â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë ______________________________________________________________________________
                                      (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, â³äîì÷à ï³äïîðÿäêîâàí³ñòü, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________

1. ³äá³ð ïðîá òà âèì³ðþâàííÿ ïðîâåäåí³ â³äïîâ³äíî äî:

ÊÍÄ 211.2.3.063-98 "Ìåòðîëîã³÷íå çàáåçïå÷åííÿ. ³äá³ð ïðîá ïðîìèñëîâèõ âèêèä³â. ²íñòðóêö³ÿ" (ç³ çì³íàìè);

ìåòîäèê âèêîíàííÿ âèì³ðþâàíü (ÌÂÂ), äîïóùåíèõ äî âèêîðèñòàííÿ òà íàâåäåíèõ ó Ïåðåë³êó
_____________________________________________________________________________________
                                                                                    (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
(äàë³ - Ïåðåë³ê). Øèôðè çàñòîñîâàíèõ Ì çà Ïåðåë³êîì íàâîäÿòüñÿ â ðîçä³ë³ 5 "Ðåçóëüòàòè âèì³ðþâàíü";

ÌÂÂ, ùî íå óâ³éøëè äî Ïåðåë³êó: _______________________________________________________
                                                                                                                     (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
_____________________________________________________________________________________.

2. Ïðè âèì³ðþâàíí³ çàñòîñîâàí³ òàê³ îñíîâí³ çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (äàë³ - ÇÂÒ):
_____________________________________________________________________________________
_____________________________________________________________________________________.
                                                                   (íàçâà, òèï, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó)

3. Ïåðåðàõóíîê âì³ñòó ÇÐ ó âèêèäàõ ïàëèâîâèêîðèñòîâóþ÷îãî îáëàäíàííÿ íà â³äïîâ³äíó îá'ºìíó ÷àñòêó êèñíþ, âèêîíàíèé â³äïîâ³äíî äî íàêàçó ̳íïðèðîäè Óêðà¿íè â³ä 27 ÷åðâíÿ 2006 ðîêó N 309 "Ïðî çàòâåðäæåííÿ íîðìàòèâ³â ãðàíè÷íîäîïóñòèìèõ âèêèä³â çàáðóäíþþ÷èõ ðå÷îâèí ³ç ñòàö³îíàðíèõ äæåðåë", çàðåºñòðîâàíîãî â ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè 01 ñåðïíÿ 2006 ðîêó çà N 912/12786, òà/àáî òåõíîëîã³÷íèõ íîðìàòèâ³â:
_____________________________________________________________________________________
                                                                               (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
_______________________________________________________________________________________.

Ñòîð. 1, âñüîãî ñòîð. _____

4. Íàçâà äîêóìåíòà, ùî ðåãëàìåíòóº çíà÷åííÿ íîðìàòèâ³â âèêèä³â, íàâåäåíèõ ó ðîçä³ë³ 5:

Äîçâ³ë íà âèêèäè çàáðóäíþþ÷èõ ðå÷îâèí â àòìîñôåðíå ïîâ³òðÿ ñòàö³îíàðíèìè äæåðåëàìè âèêèä³â N _______ âèäàíèé
_________________________________________________________________________________________________________________________
                                                                                                                             (íàéìåíóâàííÿ óñòàíîâè, äàòà)

5. Ðåçóëüòàòè âèì³ðþâàíü

Äàòè â³äáîðó ïðîá òà âèì³ðþ-
âàííÿ

Íàçâè âèðîáíèöòâà, öåõó, ä³ëüíèö³, äæåðåëà óòâîðåííÿ ÇÐ, õàðàêòåðèñòèêà òà íàâàíòàæåííÿ ï³ä ÷àñ â³äáîðó ïðîá

Íîìåð, íàçâà ÄÂ, ÄÓ;
ì³ñöå â³äáîðó ïðîá òà
D àáî A õ B
ïåðåð³çó ãàçîõîäó, ì

Ïàðàìåòðè ãàçîïèëîâîãî ïîòîêó
(ó ì³ñö³ â³äáîðó ïðîá)

Íàçâà ÇÐ

Íîìåð îá'ºäí. ïðîáè

Ìàñîâà êîíöåíòðàö³ÿ ÇÐ, rB

Ìàñîâà âèòðàòà âèêèäó ÇÐ,
q
m,
ã/ñ

Íîðìàòèâ âèêèäó

³äîìîñò³ ïðî ÌÂÂ

êîíöåíòðàö³ÿ

ìàñîâà âèòðàòà âèêèäó ÇÐ
q
m,
 
 
 
ã/ñ

ìã/ì3

ó ïåðå-
ðàõóíêó íà
_____
 
 
ìã/ì
3

rB,
ìã/ì3

rB
ó ïåðå-
ðàõóíêó íà
____
 
ìã/ì
3

øèôð ÌÂÂ

ïîõèáêà âèì³ðþâàííÿ,**
d, %, (D) Ð = 0,95

òåìïå-
ðàòóðà
t
ã,
 
°C

øâèä-
ê³ñòü
u,
 
ì/ñ

îá'ºìíà âèòðàòà
q
vî*,
 
ì
3

âì³ñò êèñíþ
jO2,
 
%

êîíöåí-
òðàö³¿ ÇÐ,
rB

ìàñîâî¿ âèòðàòè,
 
q
m

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________
* qvî - îá'ºìíà âèòðàòà, çâåäåíà äî íîðìàëüíèõ óìîâ.

** d - ïîçíà÷åííÿ õàðàêòåðèñòèê â³äíîñíî¿ ïîõèáêè òà D - ïîçíà÷åííÿ õàðàêòåðèñòèê àáñîëþòíî¿ ïîõèáêè ïðè äîâ³ð÷³é éìîâ³ðíîñò³ Ð = 0,95.

Ïðèì³òêà.

Íà÷àëüíèê ï³äðîçä³ëó

________________________________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Âèêîíàâö³

________________________________________________________
(ïîñàäè, ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

 

 

Ñòîð. __, âñüîãî ñòîð. _____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÀÊÒ
â³äáîðó ïðîá îðãàí³çîâàíèõ âèêèä³â ñòàö³îíàðíèõ äæåðåë

â³ä "___" ____________ ____ ð.

N ________

ì. ___________________

Íàìè, _______________________________________________________________________________
                                                                                   (ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________,
â ïðèñóòíîñò³ ïðåäñòàâíèêà ñóá'ºêòà ãîñïîäàðþâàííÿ ______________________________________
_____________________________________________________________________________________
                                                                          (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí)
ç ìåòîþ ______________________________________________________________________________
_____________________________________________________________________________________
íà âèêîíàííÿ _________________________________________________________________________
_____________________________________________________________________________________
âèêîíàíî â³äá³ð ïðîá â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë __________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
                                 (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, â³äîì÷à ï³äïîðÿäêîâàí³ñòü, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
                                        (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí êåð³âíèêà ñóá'ºêòà ãîñïîäàðþâàííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
     (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí â³äïîâ³äàëüíîãî çà ïðèðîäîîõîðîííó ä³ÿëüí³ñòü ñóá'ºêòà ãîñïîäàðþâàííÿ)

1. ³äá³ð ïðîá âèêîíàíî â³äïîâ³äíî äî âèìîã ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ):

ÊÍÄ 211.2.3.063-98 "Ìåòðîëîã³÷íå çàáåçïå÷åííÿ. ³äá³ð ïðîá ïðîìèñëîâèõ âèêèä³â. ²íñòðóêö³ÿ"
(ç³ çì³íàìè), __________________________________________________________________________
_____________________________________________________________________________________
                                                                                                  (íàçâà ÍÄ)

2. Çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (ÇÂÒ) òà äîïîì³æíå îáëàäíàííÿ, ùî çàñòîñîâóâàëèñü ïðè â³äáîð³
ïðîá ________________________________________________________________________________
                                                 (íàçâà ÇÂÒ òà îáëàäíàííÿ, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó ÇÂÒ)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

3. Ïàñïîðò ïðîáè                           Àêò â³äáîðó ïðîá îðãàí³çîâàíèõ âèêèä³â ñòàö³îíàðíèõ äæåðåë â³ä ____________ N _____, àðê. ____ (ñòîð. ____)

Äàòà, ÷àñ â³äáîðó ïðîáè

Äæåðåëî âèêèäó

Íàçâà ÇÐ

Íîìåð ïðîáè
(îá'ºäíàíî¿ òà òî÷êîâî¿)

Îá'ºìíà âèòðàòà ãàçó,
 
 
qvð,
 
äì
3/õâ

Òðèâà-
ë³ñòü â³äáî-
ðó,
 
Ò,
 
õâ

Ïåðåä ðîòàìåòðîì

Îá'ºì â³ä³áðàíîãî ãàçó, äì3

Ðåçóëüòàòè âèì³ðþâàíü ãàçîàíàë³çàòîð³â (ÀÌ-5, òðóáêè ³íäèêàòîðí³ ÒÈ).
Äîäàòêîâ³ â³äîìîñò³.
Øèôð ÌÂÂ

íàçâà âèðîáíèöòâà, öåõó, ä³ëüíèö³, òåõíîëîã³÷íîãî îáëàäíàííÿ (ÄÓ); íàâàíòàæåííÿ ï³ä ÷àñ â³äáîðó

íîìåð (íàçâà)

òåìïåðà-
òóðà,
 
tð,
 
°C

òèñê,
 
 
pð,
 
êÏà

çà ðîáî÷èõ óìîâ,
 
V

çâåäåíèé äî í.ó.,
 
Vî

ÄÂ; òî÷êè
(ì³ñöÿ) â³äáîðó

1

2

3

4

5

6

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Äîäàòêîâ³ â³äîìîñò³ ùîäî óìîâ â³äáîðó òà â³ä³áðàíèõ ïðîá:

4.1. Òåìïåðàòóðà íàâêîëèøíüîãî ñåðåäîâèùà á³ëÿ ì³ñöÿ â³äáîðó ïðîá __________ °C. Àòìîñôåðíèé òèñê ___________ êÏà;

4.2. ²íøå _________________________________________________________________________________________________________________.

Äî Àêòà â³äáîðó ïðîá îðãàí³çîâàíèõ âèêèä³â ñòàö³îíàðíèõ äæåðåë äîäàþòüñÿ: _______________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
                                                                                                                                  (íîìåð òà íàçâà äîäàòêà(³â))

Àêò ç äîäàòêîì(àìè): __________________________ ñêëàäåíî íà _______ àðê. ó _______ ïðèì., ó òîìó ÷èñë³ äîäàòîê(êè) íà __________ àðê.
                                                                 (íîìåð äîäàòêà(³â))

Âèêîíàâö³
â³äáîðó ïðîá

__________________________________________
__________________________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

Ïðåäñòàâíèê
ñóá'ºêòà ãîñïîäàðþâàííÿ

 
___________________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðîáè äîñòàâëåí³ äëÿ ïðîâåäåííÿ âèì³ðþâàíü ________________________________________________________________________________
                                                                                                                                                                                                    (äàòà, ÷àñ)

Çàóâàæåííÿ ùîäî ñòàíó ïðîá ³ çàïèñ³â _______________________________________________________________________________________

Âèñíîâîê ùîäî ïðèäàòíîñò³ ïðîá äëÿ ïðîâåäåííÿ âèì³ðþâàíü:

1. Ïðèäàòí³ âñ³ ïðîáè _____________________________________

2. Íå ïðèäàòí³ ïðîáè N ______________________________________                ___________________________________________________
                                                                                                                                                                                                                         (ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N ___

Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó
(ïðè âèêîðèñòàíí³ ì³êðîìàíîìåòðà ³ âèì³ðþâàíü òèñêó â êÏà)

  

  

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N ____

Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó
(ïðè âèêîðèñòàíí³ ì³êðîìàíîìåòðà ³ âèì³ðþâàíü òèñêó â ìì ðò. ñò.)

  

  

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N ____

Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó
(ïðè âèêîðèñòàíí³ âèì³ðþâà÷à øâèäêîñò³ ³ âèì³ðþâàíü òèñêó â êÏà)

  

  

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N ____

Ïðîòîêîë âèì³ðþâàíü ïàðàìåòð³â ãàçîïèëîâîãî ïîòîêó
(ïðè âèêîðèñòàíí³ âèì³ðþâà÷à øâèäêîñò³ ³ âèì³ðþâàíü òèñêó â ìì ðò. ñò.)

  

  

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N ______

Ðîçðàõóíîê âèòðàòè ãàçó ïðè â³äáîð³ ïðîá ðå÷îâèí ó âèãëÿä³ ñóñïåíäîâàíèõ òâåðäèõ ÷àñòèíîê
(ïðè âèì³ðþâàíí³ òèñêó â êÏà)

(ïèëó òà àåðîçîë³â ïðè ð - â êÏà, ä³àìåòð³ ïèëîâ³äá³ðíî¿ òðóáêè dòð = 6 ìì, ãóñòèí³ ãàçó rî = ___ êã/ì3, ãóñòèí³ ãàçó ïðè ãðàäóþâàíí³ ðîòàìåòðà rê = ____ êã/ì3)

Íîìåð

Øâèäê³ñòü,
  

Ïèëîâ³äá³ðíèé íàêîíå÷íèê

qvð,
 
äì
3/õâ

(0,0471 d 2 )

 
1,64·q
vð

 
p
ã / Òã

tð,

°C

Òð,

Ê
(273 + t
ð)

ðð,

êÏà

,
êÏà
(ð
à - ðð)

 
Ò
ð /

 
ÖÒð /

qvð', äì3/õâ
1,64 q
vð ðã/ÒãÖrî Òð /ð'ð rê

Òðèâàë³ñòü â³äáîðó,
Ò,
õâ.

V,
 
äì
3
 
(q
¢vð õ Ò)

ÄÂ,
ÄÓ

òî÷êè ïî ïåðåð³çó ãàçîõîäó

ì/ñ

Ö  

d = 24 / Ö  , ìì

d 2,

ìì2

ðîçð.

ôàêò.

ðîçð.

ôàêò.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vî = 1,583 V õ Ö (ðð' / Òð) =

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ïðèì³òêà. Çíà÷åííÿ ãðàôè 20 ìîæóòü ðîçðàõîâóâàòèñü ï³ñëÿ ñêëàäàííÿ Àêòà â³äáîðó ïðîá.

Âèêîíàâö³

_____________________________________________________________________________________________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N ______

Ðîçðàõóíîê âèòðàòè ãàçó ïðè â³äáîð³ ïðîá ðå÷îâèí ó âèãëÿä³ ñóñïåíäîâàíèõ òâåðäèõ ÷àñòèíîê
(ïðè ñòàíäàðòíîìó çíà÷åíí³ ãóñòèíè ãàçó ³ âèì³ðþâàíí³ òèñêó â êÏà)

(ïèëó òà àåðîçîë³â ïðè ð - â êÏà, ä³àìåòð³ ïèëîâ³äá³ðíî¿ òðóáêè dòð = 6 ìì, ãóñòèí³ ãàçó rî = 1,29 êã/ì3, ãóñòèí³ ãàçó ïðè ãðàäóþâàíí³ ðîòàìåòðà rê = 1,20 êã/ì3)

Íîìåð

Øâèäê³ñòü,
  

Ïèëîâ³äá³ðíèé íàêîíå÷íèê

qvð,
 
äì
3/õâ
(0,0471d
2  )

 
1,7 q
vð

 
p
ã / Òã

tð,
 
°C

Òð,
 
Ê
(273 + t
ð)

ðð,
 
êÏà

ðð',
 
êÏà
(ð
à - ðð)

 
Ò
ð / ðð'

 
 
ÖÒð / ðð'

qvð', äì3/õâ
 
1,7 q
vð ðã/Òã ÖÒð/ ðð'

Òðèâàë³ñòü â³äáîðó,
Ò,
õâ.

V,

äì3
 
(q
¢vð õ Ò)

ÄÂ,
ÄÓ

òî÷êè ïî ïåðåð³çó ãàçîõîäó

ì/ñ

Ö  

d = 24 / Ö  ,
ìì

d 2,

ìì2

ðîçð.

ôàêò.

ðîçð.

ôàêò.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vî = 1,583 V õ Ö ðð' /Òð =

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ïðèì³òêà. Çíà÷åííÿ ãðàôè 20 ìîæóòü ðîçðàõîâóâàòèñü ï³ñëÿ ñêëàäàííÿ Àêòà â³äáîðó ïðîá.

Âèêîíàâö³

____________________________________________________________________________________________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N _____

Ðîçðàõóíîê âèòðàòè ãàçó ïðè â³äáîð³ ïðîá ðå÷îâèí ó âèãëÿä³ ñóñïåíäîâàíèõ òâåðäèõ ÷àñòèíîê
(ïðè ñòàíäàðòíîìó çíà÷åíí³ ãóñòèíè ãàçó ³ âèì³ðþâàíí³ òèñêó â ìì ðò. ñò.)

(ïèëó òà àåðîçîë³â ïðè ð - â ìì ðò. ñò., ä³àìåòð³ ïèëîâ³äá³ðíî¿ òðóáêè dòð = 6 ìì, ãóñòèí³ ãàçó rî = 1,29 êã/ì3, ãóñòèí³ ãàçó ïðè ãðàäóþâàíí³ ðîòàìåòðà rê = 1,20 êã/ì3)

Íîìåð

Øâèäê³ñòü,
 

Ïèëîâ³äá³ðíèé íàêîíå÷íèê

qvð,
 
äì
3/õâ
(0,0471d
2  )

 
0,622·qvð

 
pã / Òã

tð,
 
°C

Òð,
 
Ê
(273 + t
ð)

ðð,
 
ìì ðò. ñò.

ðð',
 
ìì ðò. ñò.
(ð
à - ðð)

 
Ò
ð / ðð'

 
 
ÖÒð / ðð'

q¢vð, äì3/õâ
 
(0,622 q
vð·ðã/Òã Örî·Òð / ð'ð·rê)

Òðèâàë³ñòü â³äáîðó,
Ò,
õâ.

V,
 
äì
3
 
(q
¢vð õ Ò)

ÄÂ,
ÄÓ

òî÷êè ïî ïåðåð³çó ãàçîõîäó

ì/ñ

Ö 

d = 24 / Ö  , ìì

d 2,

ìì2

ðîçð.

ôàêò.

ðîçð.

ôàêò.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vî = 0,578 V õ Ö ðð' / Òð =

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ïðèì³òêà. Çíà÷åííÿ ãðàôè 20 ìîæóòü ðîçðàõîâóâàòèñü ï³ñëÿ ñêëàäàííÿ Àêòà â³äáîðó ïðîá.

Âèêîíàâö³

________________________________________________________________________________________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

Äîäàòîê __ äî Àêòà â³äáîðó ïðîá â³ä ____________ N _____

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N _______
âèì³ðþâàíü âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë ïàëèâîâèêîðèñòîâóþ÷îãî îáëàäíàííÿ

â³ä "___" ____________ 20__ ð.

Íàìè, _______________________________________________________________________________
                                                                   (ïîñàäè, ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________,
â ïðèñóòíîñò³ ïðåäñòàâíèêà ____________________________________________________________
                                                                 (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí)
_____________________________________________________________________________________
_____________________________________________________________________________________
ç ìåòîþ _____________________________________________________________________________
_____________________________________________________________________________________
íà âèêîíàííÿ _________________________________________________________________________
_____________________________________________________________________________________
âèêîíàíî ³íñòðóìåíòàëüíèé êîíòðîëü îðãàí³çîâàíèõ âèêèä³â çàáðóäíþþ÷èõ ðå÷îâèí íà âì³ñò:
_____________________________________________________________________________________
òà îá'ºìíî¿ ÷àñòêè òà òåìïåðàòóðè â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë ________________
_____________________________________________________________________________________
                                (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, â³äîì÷à ï³äïîðÿäêîâàí³ñòü, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
                                            (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí êåð³âíèêà ñóá'ºêòà ãîñïîäàðþâàííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
      (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí â³äïîâ³äàëüíîãî çà ïðèðîäîîõîðîííó ä³ÿëüí³ñòü ñóá'ºêòà ãîñïîäàðþâàííÿ)

1. Âèì³ðþâàííÿ âèêîíàí³ â³äïîâ³äíî äî âèìîã:

1.1. ÊÍÄ 211.2.3.063-98 "Ìåòðîëîã³÷íå çàáåçïå÷åííÿ. ³äá³ð ïðîá ïðîìèñëîâèõ âèêèä³â. ²íñòðóêö³ÿ" (ç³ çì³íàìè);

1.2. Ïàñïîðòà (Êåð³âíèöòâà ç åêñïëóàòàö³¿) ãàçîàíàë³çàòîðà _______________________.

2. Çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (ÇÂÒ) òà äîïîì³æíå îáëàäíàííÿ, ùî çàñòîñîâóâàëèñü ïðè â³äáîð³ ïðîá.

Íàçâà ÇÂÒ òà îáëàäíàííÿ

Çàâîäñüêèé íîìåð

³äîìîñò³ ïðî ïîâ³ðêó ÇÂÒ

 

 

 

 

 

 

 

 

 

 

 

 

3. Ïàñïîðò ïðîáè

Äàòà, ÷àñ âèì³ðþâàííÿ (ïî÷àòîê, çàê³í÷åííÿ)

 

Íîìåð (íàçâà) äæåðåëà âèêèäó (ÄÂ)
òà/àáî äæåðåëà óòâîðåííÿ (ÄÓ)

 

Íîìåð (íàçâà) âèðîáíèöòâà, öåõó, ä³ëüíèö³

 

Âèä ïàëèâà òà íàâàíòàæåííÿ òåõíîëîã³÷íîãî îáëàäíàííÿ ï³ä ÷àñ âèì³ðþâàíü

 

Íîìåð (íàçâà) òî÷êè (ì³ñöÿ) âèì³ðþâàííÿ

 

Òðèâàë³ñòü îäíîãî öèêëó âèì³ðþâàííÿ Ò, õâ.

 

Íîìåð îá'ºäíàíî¿ òà òî÷êîâî¿ ïðîáè

Ïîêàç ÇÂÒ

  
%

jCO,
ìëí-1

  
ìëí-1

jNO,
ìëí-1

  
ìëí-1

tã,
°C

h

  
ìëí-1

(KrCO = 1,25)

(KrSO2 = 2,86)

(KrNO = 1,34)

(KrNO2 = 2,05)

(KrNOx = 2,05)

1-1

 

 

 

 

 

 

 

 

1-2

 

 

 

 

 

 

 

 

1-3

 

 

 

 

 

 

 

 

1-4

 

 

 

 

 

 

 

 

(å1-4)/4

 

 

 

 

 

 

 

 

 , ìã/ì3

õ

 

 

 

 

õ

õ

 

  õ  

õ

 

 

 

 

õ

õ

 

2-1

 

 

 

 

 

 

 

 

2-2

 

 

 

 

 

 

 

 

2-3

 

 

 

 

 

 

 

 

2-4

 

 

 

 

 

 

 

 

(å1-4)/4

 

 

 

 

 

 

 

 

 , ìã/ì3

õ

 

 

 

 

õ

õ

 

  õ  

õ

 

 

 

 

õ

õ

 

3-1

 

 

 

 

 

 

 

 

3-2

 

 

 

 

 

 

 

 

3-3

 

 

 

 

 

 

 

 

3-4

 

 

 

 

 

 

 

 

(å1-4)/4

 

 

 

 

 

 

 

 

 , ìã/ì3

õ

 

 

 

 

õ

õ

 

  õ  

õ

 

 

 

 

õ

õ

 

4. Äîäàòêîâ³ â³äîìîñò³ ùîäî óìîâ ïðîâåäåííÿ â³äáîðó ïðîá:

4.1. Òåìïåðàòóðà íàâêîëèøíüîãî ñåðåäîâèùà á³ëÿ ì³ñöÿ â³äáîðó ïðîá _______ °C;

4.2. Àòìîñôåðíèé òèñê ________ êÏà (ìì ðò. ñò.);

4.3. Óìîâè, íå ïåðåäáà÷åí³ ÊÍÄ 211.2.3.063-98 ____________________________________________
_____________________________________________________________________________________.

Ïðèì³òêà. ____________________________________________________________________________
_____________________________________________________________________________________

Âèêîíàâö³

________________________
________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðåäñòàâíèê
ñóá'ºêòà ãîñïîäàðþâàííÿ

 
______________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

Ñòîð. ___, âñüîãî ñòîð. ____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N _______
âèì³ðþâàíü âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë ïàëèâîâèêîðèñòîâóþ÷îãî îáëàäíàííÿ

â³ä "___" ____________ 20__ ð.

Íàìè, _______________________________________________________________________________
                                        (ïîñàäè, ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________,
â ïðèñóòíîñò³ ïðåäñòàâíèêà _____________________________________________________________
                                                                   (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí)
_____________________________________________________________________________________
_____________________________________________________________________________________
ç ìåòîþ ______________________________________________________________________________
íà âèêîíàííÿ _________________________________________________________________________
âèêîíàíî âèì³ðþâàííÿ âì³ñòó çàáðóäíþþ÷èõ ðå÷îâèí, îá'ºìíî¿ ÷àñòêè êèñíþ òà òåìïåðàòóðè â îðãàí³çîâàíèõ âèêèäàõ ñòàö³îíàðíèõ äæåðåë _______________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
                                    (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, â³äîì÷à ï³äïîðÿäêîâàí³ñòü, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
                                       (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí êåð³âíèêà ñóá'ºêòà ãîñïîäàðþâàííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
     (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí â³äïîâ³äàëüíîãî çà ïðèðîäîîõîðîííó ä³ÿëüí³ñòü ñóá'ºêòà ãîñïîäàðþâàííÿ)

1. Âèì³ðþâàííÿ âèêîíàí³ â³äïîâ³äíî äî âèìîã:

1.1. ÊÍÄ 211.2.3.063-98 "Ìåòðîëîã³÷íå çàáåçïå÷åííÿ. ³äá³ð ïðîá ïðîìèñëîâèõ âèêèä³â. ²íñòðóêö³ÿ" (ç³ çì³íàìè);

1.2. Ïàñïîðòà (Êåð³âíèöòâà ç åêñïëóàòàö³¿) ãàçîàíàë³çàòîðà _________________________________.

2. Çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (ÇÂÒ) òà äîïîì³æíå îáëàäíàííÿ, ùî çàñòîñîâóâàëèñü ïðè â³äáîð³ ïðîá

Íàçâà ÇÂÒ òà îáëàäíàííÿ

Çàâîäñüêèé íîìåð

³äîìîñò³ ïðî ïîâ³ðêó ÇÂÒ

 

 

 

 

 

 

 

 

 

3. Ïàñïîðò ïðîáè

Äàòà, ÷àñ âèì³ðþâàííÿ (ïî÷àòîê, çàê³í÷åííÿ)

 

Íîìåð (íàçâà) äæåðåëà âèêèäó (ÄÂ)
òà/àáî äæåðåëà óòâîðåííÿ (ÄÓ)

 

Íîìåð (íàçâà) âèðîáíèöòâà, öåõó, ä³ëüíèö³

 

Âèä ïàëèâà òà íàâàíòàæåííÿ òåõíîëîã³÷íîãî îáëàäíàííÿ ï³ä ÷àñ âèì³ðþâàíü

 

Íîìåð (íàçâà) òî÷êè (ì³ñöÿ) âèì³ðþâàííÿ

 

Òðèâàë³ñòü îäíîãî öèêëó âèì³ðþâàííÿ Ò, õâ.

 

Íîìåð îá'ºäíàíî¿ òà òî÷êîâî¿ ïðîáè

Ïîêàç ÇÂÒ

  
%

jCO,
ìëí-1

 
ìëí-1

jNO,
ìëí-1

  
ìëí-1

tã,
°C

h

  
ìëí-1

(KrCO = 1,25)

(KrSO2 = 2,86)

(KrNO = 1,34)

(KrNO2 = 2,05)

(KrNOx = 2,05)

1-1

 

 

 

 

 

 

 

 

1-2

 

 

 

 

 

 

 

 

1-3

 

 

 

 

 

 

 

 

1-4

 

 

 

 

 

 

 

 

(å1-4)/4

 

 

 

 

 

 

 

 

 , ìã/ì3

õ

 

 

 

 

õ

õ

 

  õ  

õ

 

 

 

 

õ

õ

 

2-1

 

 

 

 

 

 

 

 

2-2

 

 

 

 

 

 

 

 

2-3

 

 

 

 

 

 

 

 

2-4

 

 

 

 

 

 

 

 

(å1-4)/4

 

 

 

 

 

 

 

 

 , ìã/ì3

õ

 

 

 

 

õ

õ

 

  õ  

õ

 

 

 

 

õ

õ

 

3-1

 

 

 

 

 

 

 

 

3-2

 

 

 

 

 

 

 

 

3-3

 

 

 

 

 

 

 

 

3-4

 

 

 

 

 

 

 

 

(å1-4)/4

 

 

 

 

 

 

 

 

 , ìã/ì3

õ

 

 

 

 

õ

õ

 

  õ  

õ

 

 

 

 

õ

õ

 

4. Äîäàòêîâ³ â³äîìîñò³ ùîäî óìîâ ïðîâåäåííÿ â³äáîðó ïðîá:

4.1. Òåìïåðàòóðà íàâêîëèøíüîãî ñåðåäîâèùà á³ëÿ ì³ñöÿ â³äáîðó ïðîá ____ °C;

4.2. Àòìîñôåðíèé òèñê ________ êÏà (ìì ðò. ñò.);

4.3. Óìîâè, íå ïåðåäáà÷åí³ ÊÍÄ 211.2.3.063-98 ____________________________________________
_____________________________________________________________________________________.

Ïðèì³òêà. ____________________________________________________________________________

Âèêîíàâö³

________________________
________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðåäñòàâíèê
ñóá'ºêòà ãîñïîäàðþâàííÿ

 
______________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

Ñòîð. ___, âñüîãî ñòîð. ____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

_____________________________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N _______
âèì³ðþâàíü âì³ñòó åêîëîã³÷íèõ ïîêàçíèê³â íàôòîïðîäóêò³â

â³ä "___" ____________ 20__ ð.

³äïîâ³äíî äî Àêòà â³äáîðó ïðîá íàôòîïðîäóêò³â, ÿê³ ðåàë³çóþòüñÿ øëÿõîì îïòîâî¿ òà ðîçäð³áíî¿ òîðã³âë³ â³ä ____________ N _______ ____________________________________________________
____________________________________________________________________________________,
                                                      (íàéìåíóâàííÿ ï³äðîçä³ëó ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ)
àòåñòîâàíèì íà ïðàâî âèêîíàííÿ âèì³ðþâàíü (Ñâ³äîöòâî ïðî àòåñòàö³þ N ______ â³ä ____________,
âèäàíå ______________________________________________________________________________),
                                                                                            (íàéìåíóâàííÿ îðãàíó ç àòåñòàö³¿)
ïðîâåäåíî âèì³ðþâàííÿ âì³ñòó åêîëîã³÷íèõ ïîêàçíèê³â íàôòîïðîäóêò³â ó ïðîáàõ, â³ä³áðàíèõ
_____________________________________________________________________________________
                                                                                  (êèì; ïîñèëàííÿ íà àêò â³äáîðó ïðîá)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
                                                            (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ì³ñöåçíàõîäæåííÿ)

_____________________________________________________________________________________

1. Âèì³ðþâàííÿ ïðîâåäåí³ â³äïîâ³äíî äî âèìîã ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ):
_____________________________________________________________________________________
                                                                                                     (íàçâà ÍÄ)
_____________________________________________________________________________________

2. Ïðè âèì³ðþâàíí³ çàñòîñîâàí³ òàê³ îñíîâí³ çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (äàë³ - ÇÂÒ):
_____________________________________________________________________________________
                                                                   (íàçâà, òèï, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó)
_____________________________________________________________________________________
_____________________________________________________________________________________

3. Íàçâà äîêóìåíòà, ùî ðåãëàìåíòóº çíà÷åííÿ íîðìàòèâ³â åêîëîã³÷íèõ ïîêàçíèê³â, ùî íàâåäåí³ â ðîçä³ë³ 4:
_____________________________________________________________________________________
_____________________________________________________________________________________

Ñòîð. 1, âñüîãî ñòîð. __

4. Ðåçóëüòàòè âèì³ðþâàíü

Äàòà â³äáîðó ïðîá

Íîìåð

Äàòà ïðîâåäåííÿ âèì³ðþâàíü

Íàçâà òà òèï íàôòîïðîäóêòó

Ïîêàçíèê

³äîìîñò³ ïðî ÌÂÂ

àêòà â³äáîðó ïðîá

ïðîáè

íàçâà

ïîçíà÷åííÿ îäèíèö³ âèì³ðþâàííÿ

ðåçóëüòàò âèì³ðþâàííÿ

íîðìîâàíå çíà÷åííÿ

ïîçíà÷åííÿ

ïîõèáêà âèì³ðþâàííÿ d, (D)*

çà àêòîì â³äáîðó

ðåºñòðà-
ö³éíèé

1

2

3

4

5

6

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________
* d - ïîçíà÷åííÿ õàðàêòåðèñòèê â³äíîñíî¿ ïîõèáêè òà D - ïîçíà÷åííÿ õàðàêòåðèñòèê àáñîëþòíî¿ ïîõèáêè ïðè äîâ³ð÷³é éìîâ³ðíîñò³ Ð = 0,95.

Íà÷àëüíèê ï³äðîçä³ëó

_________________________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Âèêîíàâö³

_________________________________________________
(ïîñàäè, ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

Ñòîð. ___, âñüîãî ñòîð. ___

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N _______
âèì³ðþâàíü ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé âîä

â³ä "___" ____________ ____ ð.

³äïîâ³äíî äî Àêòà â³äáîðó ïðîá âîä â³ä ______________ N ________ ________________________
_____________________________________________________________________________________,
                                            (íàéìåíóâàííÿ ï³äðîçä³ëó ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ)
àòåñòîâàíèì íà ïðàâî âèêîíàííÿ âèì³ðþâàíü (Ñâ³äîöòâî ïðî àòåñòàö³þ N _____ â³ä ____________,
âèäàíå ______________________________________________________________________________),
                                                                                      (íàéìåíóâàííÿ îðãàíó ç àòåñòàö³¿)
ïðîâåäåíî âèì³ðþâàííÿ ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé çâîðîòíèõ âîä _____________________
_____________________________________________________________________________________
                                                           (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
òà/àáî ïîâåðõíåâèõ âîä _________________________________________________________________
                                                                                                                       (íàçâà âîäíîãî îá'ºêòà)

1. ³äá³ð ïðîá âîä ïðîâåäåíî â³äïîâ³äíî äî ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ), ïåðåë³ê ÿêèõ íàâåäåíèé â Àêò³ â³äáîðó ïðîá âîä.

2. Âèì³ðþâàííÿ ïðîâåäåí³ â³äïîâ³äíî äî:

ìåòîäèê âèêîíàííÿ âèì³ðþâàíü (äàë³ - ÌÂÂ), äîïóùåíèõ äî âèêîðèñòàííÿ òà íàâåäåíèõ ó Ïåðåë³êó
_____________________________________________________________________________________
                                                                                     (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
(äàë³ - Ïåðåë³ê). Øèôðè çàñòîñîâàíèõ Ì çà Ïåðåë³êîì íàâîäÿòüñÿ â ðîçä³ë³ 5 "Ðåçóëüòàòè âèì³ðþâàíü";

ÌÂÂ, ùî íå óâ³éøëè äî Ïåðåë³êó: _______________________________________________________
                                                                                                                     (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)

3. Ïðè âèì³ðþâàíí³ çàñòîñîâàí³ òàê³ îñíîâí³ çàñîáè âèì³ðþâàëüíî¿ òåõí³êè: ____________________
_____________________________________________________________________________________
                                                                    (íàçâà, òèï, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó)

4. Íàçâà äîêóìåíòà, ÿêèé ðåãëàìåíòóº íîðìîâàí³ çíà÷åííÿ âì³ñòó ïîêàçíèê³â, ùî íàâåäåí³ â ðîçä³ë³ 5.

4.1. Ïîâåðõíåâ³ âîäè - ãðàíè÷íî äîïóñòèìà êîíöåíòðàö³ÿ (äàë³ - ÃÄÊ) çà:

4.1.1. ________________________________________________________________________________;
                                                                                                            (íàçâà ÍÄ)

4.1.2. ________________________________________________________________________________.
                                                                                                             (íàçâà ÍÄ)

4.2. Çâîðîòí³ âîäè - äîïóñòèìà êîíöåíòðàö³ÿ ÑÄ, íàâåäåíà â "Ãðàíè÷íî äîïóñòèìîìó ñêèä³ (ÃÄÑ) ðå÷îâèí ó âîäíèé îá'ºêò ³ç çâîðîòíèìè âîäàìè ï³äïðèºìñòâà", ðåãëàìåíò³ òîùî, çàòâåðäæåíîìó
_____________________________________________________________________________________
                                                                                               (íàçâà óñòàíîâè, äàòà)

4.3. ϳäçåìí³ âîäè (³ç ñïîñòåðåæóâàëüíèõ ñâåðäëîâèí) - äîïóñòèìà êîíöåíòðàö³ÿ ÑÄ

_____________________________________________________________________________________
                                                                                               (íàçâà äîêóìåíòà)

Ñòîð. 1, âñüîãî ñòîð. ____

5. Ðåçóëüòàòè âèì³ðþâàíü

Äàòè â³äáîðó òà âèì³ðþâàííÿ

Íîìåð ïðîáè

Òî÷êà ³ ì³ñöå â³äáîðó (ïðèâ'ÿçêà äî ì³ñöåâîñò³)

Ïîêàçíèê

³äîìîñò³ ïðî ÌÂÂ

çà àêòîì â³äáîðó

ðåºñòðàö³éíèé

íàçâà

ïîçíà÷åííÿ îäèíèö³ âèì³ðþâàííÿ

ðåçóëüòàò âèì³ðþâàííÿ

íîðìîâàíå çíà÷åííÿ

øèôð

ïîõèáêà âèì³ðþâàííÿ,
d, (D)*,

Ð = 0,95

ÃÄÊ

ÑÄ

ÑÄ

çà 4.1.1

çà 4.1.2

çà 4.2

çà 4.3

1

2

3

4

5

6

7

8

9

10

11

12

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________
* d - ïîçíà÷åííÿ õàðàêòåðèñòèêè â³äíîñíî¿ ïîõèáêè, (D) - ïîçíà÷åííÿ õàðàêòåðèñòèêè àáñîëþòíî¿ ïîõèáêè.

Íà÷àëüíèê ï³äðîçä³ëó

______________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Âèêîíàâö³

______________________________________
______________________________________
(ïîñàäè, ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

Ñòîð. ___, âñüîãî ñòîð. ____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N ________
âèçíà÷åííÿ ãîñòðî¿ òîêñè÷íîñò³ âîä

â³ä "___" ____________ ____ ð.

³äïîâ³äíî äî Àêòà â³äáîðó ïðîá âîä â³ä ____________ N ________ ___________________________
_____________________________________________________________________________________,
                                                    (íàéìåíóâàííÿ ï³äðîçä³ëó ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ)
àòåñòîâàíèì íà ïðàâî âèêîíàííÿ âèì³ðþâàíü (Ñâ³äîöòâî ïðî àòåñòàö³þ N ______ â³ä ____________,
âèäàíå ______________________________________________________________________________),
                                                                                         (íàéìåíóâàííÿ îðãàíó ç àòåñòàö³¿)
ïðîâåäåíî âèçíà÷åííÿ ãîñòðî¿ òîêñè÷íîñò³ ó ïðîáàõ çâîðîòíèõ âîä
_____________________________________________________________________________________
                                                            (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
                                                                                              (íàçâà âîäíîãî îá'ºêòà)

1. ³äá³ð ïðîá âîä ïðîâåäåíî â³äïîâ³äíî äî ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ), ïåðåë³ê ÿêèõ íàâåäåíèé â Àêò³ â³äáîðó ïðîá âîä.

2. Âèçíà÷åííÿ ãîñòðî¿ òîêñè÷íîñò³ ïðîâåäåíî â³äïîâ³äíî äî:

ìåòîäèê âèêîíàííÿ âèì³ðþâàíü (äàë³ - ÌÂÂ), äîïóùåíèõ äî âèêîðèñòàííÿ òà íàâåäåíèõ ó Ïåðåë³êó
_____________________________________________________________________________________
                                                                               (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
(äàë³ - Ïåðåë³ê). Øèôðè çàñòîñîâàíèõ Ì çà Ïåðåë³êîì íàâîäÿòüñÿ â ðîçä³ë³ 5 "Ðåçóëüòàòè âèì³ðþâàíü";

ÌÂÂ, ùî íå óâ³éøëè äî Ïåðåë³êó: _______________________________________________________
                                                                                                                   (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)

3. Îö³íêà ÿêîñò³ çâîðîòíèõ âîä çà êëàñîì ³ ñòóïåíåì òîêñè÷íîñò³ ïðîâåäåíà â³äïîâ³äíî äî
_____________________________________________________________________________________
                                                                                                     (íàçâà ÍÄ)
_____________________________________________________________________________________

4. Íîðìîâàí³ çíà÷åííÿ ïîêàçíèê³â (êëàñ òà ñòóï³íü òîêñè÷íîñò³) íàâåäåí³ ó "Ãðàíè÷íî äîïóñòèìîìó ñêèä³ (ÃÄÑ) ðå÷îâèí ó âîäíèé îá'ºêò ³ç çâîðîòíèìè âîäàìè ï³äïðèºìñòâà", ðåãëàìåíò³ òîùî, çàòâåðäæåíîìó
_____________________________________________________________________________________
                                                                                          (íàçâà óñòàíîâè, äàòà)
_____________________________________________________________________________________

Ñòîð. 1, âñüîãî ñòîð. ___

5. Ðåçóëüòàòè âèçíà÷åíü

Äàòè â³äáîðó òà âèçíà÷åííÿ

Íîìåð ïðîáè

Òî÷êà ³ ì³ñöå â³äáîðó
(ïðèâ'ÿçêà äî ì³ñöåâîñò³)

Ïîêàçíèê

³äîìîñò³ ïðî ÌÂÂ

çà àêòîì â³äáîðó

ðåºñòðàö³éíèé

íàçâà

ðåçóëüòàò âèçíà÷åííÿ

íîðìîâàíå çíà÷åííÿ

øèôð/íàçâà

ïîõèáêà âèçíà÷åííÿ,
d, (D)*

1

2

3

4

5

6

7

8

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________
* d - ïîçíà÷åííÿ õàðàêòåðèñòèêè â³äíîñíî¿ ïîõèáêè, (D) - ïîçíà÷åííÿ õàðàêòåðèñòèêè àáñîëþòíî¿ ïîõèáêè.

Íà÷àëüíèê ï³äðîçä³ëó

______________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Âèêîíàâö³

______________________________________
______________________________________
(ïîñàäè, ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

Ñòîð. ___, âñüîãî ñòîð. ____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N __________________
âèçíà÷åííÿ õðîí³÷íî¿ òîêñè÷íîñò³ âîä

â³ä "___" ____________ ____ ð.

³äïîâ³äíî äî Àêòà â³äáîðó ïðîá âîä â³ä ____________ N ___________________________________
_____________________________________________________________________________________,
                                                 (íàéìåíóâàííÿ ï³äðîçä³ëó ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ)
àòåñòîâàíèì íà ïðàâî âèêîíàííÿ âèì³ðþâàíü (Ñâ³äîöòâî ïðî àòåñòàö³þ N ______ â³ä ____________,
âèäàíå ______________________________________________________________________________),
                                                                                   (íàéìåíóâàííÿ îðãàíó ç àòåñòàö³¿)
ïðîâåäåíî âèçíà÷åííÿ õðîí³÷íî¿ òîêñè÷íîñò³ ó ïðîáàõ âîä ___________________________________
_____________________________________________________________________________________
                                                                                            (íàçâà âîäíîãî îá'ºêòà)

1. ³äá³ð ïðîá âîä ïðîâåäåíî â³äïîâ³äíî äî ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ), ïåðåë³ê ÿêèõ íàâåäåíèé â Àêò³ â³äáîðó ïðîá âîä.

2. Âèçíà÷åííÿ õðîí³÷íî¿ òîêñè÷íîñò³ ïðîâåäåíî â³äïîâ³äíî äî:

ìåòîäèê âèêîíàííÿ âèì³ðþâàíü (äàë³ - ÌÂÂ), äîïóùåíèõ äî âèêîðèñòàííÿ òà íàâåäåíèõ ó Ïåðåë³êó
_____________________________________________________________________________________
                                                                                  (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
(äàë³ - Ïåðåë³ê). Øèôðè çàñòîñîâàíèõ Ì çà Ïåðåë³êîì íàâîäÿòüñÿ â ðîçä³ë³ 4 "Ðåçóëüòàòè âèì³ðþâàíü";

ÌÂÂ, ùî íå óâ³éøëè äî Ïåðåë³êó: _______________________________________________________
                                                                                                                   (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)

3. Íîðìîâàí³ çíà÷åííÿ ïîêàçíèêà, íàâåäåíîãî â ðîçä³ë³ 4 "Ðåçóëüòàòè âèçíà÷åíü", ðåãëàìåíòîâàí³
_____________________________________________________________________________________
                                                                                                      (íàçâà ÍÄ)
_____________________________________________________________________________________

Ñòîð. 1, âñüîãî ñòîð. ____

4. Ðåçóëüòàòè âèçíà÷åíü

Äàòè â³äáîðó òà âèçíà÷åííÿ

Íîìåð ïðîáè

Òî÷êà ³ ì³ñöå â³äáîðó
(ïðèâ'ÿçêà äî ì³ñöåâîñò³)

Ïîêàçíèê

³äîìîñò³ ïðî ÌÂÂ

çà àêòîì â³äáîðó

ðåºñòðàö³éíèé

íàçâà

ðåçóëüòàò âèçíà÷åííÿ

íîðìîâàíå çíà÷åííÿ

øèôð/íàçâà

ïîõèáêà âèçíà÷åííÿ,
d, (D)*

1

2

3

4

5

6

7

8

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________
* d - ïîçíà÷åííÿ õàðàêòåðèñòèêè â³äíîñíî¿ ïîõèáêè, (D) - ïîçíà÷åííÿ õàðàêòåðèñòèêè àáñîëþòíî¿ ïîõèáêè.

Íà÷àëüíèê ï³äðîçä³ëó

______________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Âèêîíàâö³

______________________________________
______________________________________
(ïîñàäè, ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

Ñòîð. ___, âñüîãî ñòîð. ____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÀÊÒ
â³äáîðó ïðîá âîä

â³ä "___" ____________ ____ ð.

N ________

ì. ___________________

Íàìè, _______________________________________________________________________________
                                                                           (ïîñàäè, ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________,
â ïðèñóòíîñò³ ïðåäñòàâíèêà _____________________________________________________________
                                                                 (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
ç ìåòîþ ______________________________________________________________________________
_____________________________________________________________________________________
íà âèêîíàííÿ _________________________________________________________________________
âèêîíàíî â³äá³ð ïðîá çâîðîòíèõ âîä ______________________________________________________
                                                              (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, â³äîì÷à ï³äïîðÿäêîâàí³ñòü, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
                                          (ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí êåð³âíèêà ñóá'ºêòà ãîñïîäàðþâàííÿ)
_____________________________________________________________________________________
(ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí â³äïîâ³äàëüíîãî çà ïðèðîäîîõîðîííó ä³ÿëüí³ñòü ñóá'ºêòà ãîñïîäàðþâàííÿ)
òà ïîâåðõíåâèõ âîä ____________________________________________________________________
                                                                                                                 (íàçâà âîäíîãî îá'ºêòà)

1. ³äá³ð ïðîá ïðîâåäåíî â³äïîâ³äíî äî âèìîã ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ): _____________________________________________________________________________________
                                                                                                  (íàçâà ÍÄ)
_____________________________________________________________________________________
_____________________________________________________________________________________

Ïðîöåäóðè ùîäî çáåð³ãàííÿ òà ïîâîäæåííÿ ç ïðîáàìè ïðîâåäåíî â³äïîâ³äíî äî âèìîã
_____________________________________________________________________________________
                                                                                                    (íàçâà ÍÄ)
_____________________________________________________________________________________

2. Çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (äàë³ - ÇÂÒ) òà äîïîì³æíå îáëàäíàííÿ, ùî çàñòîñîâóâàëèñü ïðè â³äáîð³ ïðîá __________________________________________________________________________
                                                               (íàçâà ÇÂÒ òà îáëàäíàííÿ, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó ÇÂÒ)
_____________________________________________________________________________________

3. Ïàñïîðò ïðîáè

Àêò â³äáîðó ïðîá âîä â³ä ____________ N _________, àðê. _____ (ñòîð. _____)

Äàòà, ÷àñ â³äáîðó

Íîìåð ïðîáè

Òî÷êà ³ ì³ñöå â³äáîðó (ïðèâ'ÿçêà äî ì³ñöåâîñò³);
ãëèáèíà â³äáîðó, ì

Âèä ïðîáè:
ðàçîâà, îá'ºäíàíà
(óñåðåäíåíà)

Çàãàëüíèé îá'ºì ïðîáè,
äì3

Ïîêàçíèêè, ùî ï³äëÿãàþòü âèì³ðþâàííþ

Ïîñóäèíà äëÿ ïðîáè

Ïîêàçíèêè, ùî âèçíà÷àëèñü íà ì³ñö³

³äîìîñò³ ïðî ïîïåðåäíþ îáðîáêó ïðîáè

íîìåð,
òèï

îá'ºì,
äì3

òåìïåðàòóðà
t, °C

âîäíåâèé ïîêàçíèê,
îä. pH

ðîç÷èíåíèé êèñåíü,
ìã/äì3

1

2

3

4

5

6

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Äîäàòêîâ³ â³äîìîñò³ ñòîñîâíî óìîâ â³äáîðó òà â³ä³áðàíèõ ïðîá:

4.1. Ìåòåîðîëîã³÷í³ ñïîñòåðåæåííÿ â³äáîðó __________________________________________________________________________________;

4.2. ²íøå ________________________________________________________________________________________________________________.

Äî Àêòà â³äáîðó ïðîá âîä äîäàþòüñÿ: ________________________________________________________________________________________.
                                                                                                                                                                        (íîìåð òà íàçâà äîäàòêà(³â))
_________________________________________________________________________________________________________________________

Àêò ç äîäàòêîì(àìè): ______________ ñêëàäåíî íà _____ àðê. ó _____ ïðèì., ó òîìó ÷èñë³ äîäàòîê(è) íà _____ àðê.
                                                    (íîìåð äîäàòê³â)

Âèêîíàâö³
â³äáîðó ïðîá

_______________________________________
_______________________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðåäñòàâíèê
ñóá'ºêòà ãîñïîäàðþâàííÿ

 
____________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

Ïðîáè äîñòàâëåí³ äëÿ ïðîâåäåííÿ âèì³ðþâàíü ________________________________________________________________________________
                                                                                                                                                                                                 (äàòà, ÷àñ)

Çàóâàæåííÿ ùîäî ñòàíó ïðîá ³ çàïèñ³â _______________________________________________________________________________________

Âèñíîâîê ùîäî ïðèäàòíîñò³ ïðîá äëÿ ïðîâåäåííÿ âèì³ðþâàíü:

1. Ïðèäàòí³ âñ³ ïðîáè _____________________________________

2. Íå ïðèäàòí³ ïðîáè N ______________________________________           _______________________________________________________
                                                                                                                                                                                                                          (ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N ________
âèì³ðþâàíü ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé ´ðóíò³â

â³ä "___" ____________ ____ ð.

³äïîâ³äíî äî Àêòà â³äáîðó ïðîá ´ðóíò³â â³ä ____________ N _________ ______________________
____________________________________________________________________________________,
                                                      (íàéìåíóâàííÿ ï³äðîçä³ëó ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ)
àòåñòîâàíèì íà ïðàâî âèêîíàííÿ âèì³ðþâàíü (Ñâ³äîöòâî ïðî àòåñòàö³þ N ______ â³ä ____________,
âèäàíå ______________________________________________________________________________),
                                                                                            (íàéìåíóâàííÿ îðãàíó ç àòåñòàö³¿)
ïðîâåäåíî âèì³ðþâàííÿ ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé ´ðóíò³â, â³ä³áðàíèõ íà òåðèòî𳿠______
_____________________________________________________________________________________
                                                            (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________

1. ³äá³ð ïðîá ´ðóíò³â ïðîâåäåíî â³äïîâ³äíî äî ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ), ïåðåë³ê ÿêèõ íàâåäåíèé â Àêò³ â³äáîðó ïðîá ãðóíò³â.

2. Âèì³ðþâàííÿ ïðîâåäåí³ â³äïîâ³äíî äî:

ìåòîäèê âèêîíàííÿ âèì³ðþâàíü (äàë³ - ÌÂÂ), äîïóùåíèõ äî âèêîðèñòàííÿ òà íàâåäåíèõ ó Ïåðåë³êó
_____________________________________________________________________________________
                                                                                    (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
_____________________________________________________________________________________
(äàë³ - Ïåðåë³ê). Øèôðè çàñòîñîâàíèõ Ì çà Ïåðåë³êîì íàâîäÿòüñÿ â ðîçä³ë³ 5 "Ðåçóëüòàòè âèì³ðþâàíü";

ÌÂÂ, ùî íå óâ³éøëè äî Ïåðåë³êó: _______________________________________________________
                                                                                                                      (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
_____________________________________________________________________________________

3. Ïðè âèì³ðþâàíí³ çàñòîñîâàí³ òàê³ îñíîâí³ çàñîáè âèì³ðþâàëüíî¿ òåõí³êè: ____________________
_____________________________________________________________________________________
                                                                     (íàçâà, òèï, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó)

4. Íîðìîâàíèé âì³ñò ãðàíè÷íî äîïóñòèìèõ êîíöåíòðàö³é (äàë³ - ÃÄÊ) ïîêàçíèê³â ó ðîçä³ë³ 5 "Ðåçóëüòàòè âèì³ðþâàíü" íàâåäåíî â³äïîâ³äíî äî:
_____________________________________________________________________________________
                                                                                                     (íàçâà ÍÄ)

Ñòîð. 1, âñüîãî ñòîð. ___

5. Ðåçóëüòàòè âèì³ðþâàíü

Íîìåð ïðîáè

Äàòè â³äáîðó òà âèì³ðþâàííÿ

̳ñöå â³äáîðó, ïðèâ'ÿçêà äî ì³ñöåâîñò³

Ïëîùà çåìåëüíî¿ ä³ëÿíêè,
ì2

Ãëèáèíà â³äáîðó,
ì

Ïîêàçíèê

³äîìîñò³ ïðî Ì (øèôð òà ïîõèáêà âèì³ðþâàííÿ*,
Ð = 0,95)

íàçâà

ïîçíà÷åííÿ îäèíèö³ âèì³ðþâàííÿ

ðåçóëüòàò âèì³ðþâàííÿ

íîðìîâàíèé âì³ñò

ÃÄÊ

ôîíîâèé

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____________
* Ïîçíà÷åííÿ òà íàçâà ïîõèáêè âèì³ðþâàííÿ.

Íà÷àëüíèê ï³äðîçä³ëó

______________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Âèêîíàâö³

______________________________________
______________________________________
(ïîñàäè, ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

Ñòîð. ___, âñüîãî ñòîð. ____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÏÐÎÒÎÊÎË N ________
âèì³ðþâàíü ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé â³äõîä³â

â³ä "___" ____________ ____ ð.

³äïîâ³äíî äî Àêòà â³äáîðó ïðîá â³äõîä³â â³ä ______________ N ________ _____________________
_____________________________________________________________________________________,
                                             (íàéìåíóâàííÿ ï³äðîçä³ëó ³íñòðóìåíòàëüíî-ëàáîðàòîðíîãî êîíòðîëþ)
àòåñòîâàíèì íà ïðàâî âèêîíàííÿ âèì³ðþâàíü (Ñâ³äîöòâî ïðî àòåñòàö³þ N ______ â³ä ____________,
âèäàíå ______________________________________________________________________________),
                                                                                      (íàéìåíóâàííÿ îðãàíó ç àòåñòàö³¿)
ïðîâåäåíî âèì³ðþâàííÿ ïîêàçíèê³â ñêëàäó òà âëàñòèâîñòåé â³äõîä³â, â³ä³áðàíèõ íà ______________
_____________________________________________________________________________________
                                                         (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________

1. ³äá³ð ïðîá â³äõîä³â ïðîâåäåíî â³äïîâ³äíî äî ÷èííèõ íîðìàòèâíèõ äîêóìåíò³â (äàë³ - ÍÄ), ïåðåë³ê ÿêèõ íàâåäåíèé â Àêò³ â³äáîðó ïðîá â³äõîä³â.

2. Âèì³ðþâàííÿ ïðîâåäåí³ â³äïîâ³äíî äî:

ìåòîäèê âèêîíàííÿ âèì³ðþâàíü (äàë³ - ÌÂÂ), äîïóùåíèõ äî âèêîðèñòàííÿ òà íàâåäåíèõ ó Ïåðåë³êó
_____________________________________________________________________________________
                                                                               (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
_____________________________________________________________________________________
(äàë³ - Ïåðåë³ê). Øèôðè çàñòîñîâàíèõ Ì çà Ïåðåë³êîì íàâîäÿòüñÿ â ðîçä³ë³ 4 "Ðåçóëüòàòè âèì³ðþâàíü";

ÌÂÂ, ùî íå óâ³éøëè äî Ïåðåë³êó: _______________________________________________________
                                                                                                                     (íàçâà, â³äîìîñò³ ïðî çàòâåðäæåííÿ)
_____________________________________________________________________________________.

3. Ïðè âèì³ðþâàíí³ çàñòîñîâàí³ òàê³ îñíîâí³ çàñîáè âèì³ðþâàëüíî¿ òåõí³êè: ____________________
_____________________________________________________________________________________
                                                               (íàçâà, òèï, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó)

Ñòîð. 1, âñüîãî ñòîð. ____

4. Ðåçóëüòàòè âèì³ðþâàíü

Íîìåð ïðîáè

Äàòè â³äáîðó òà âèì³ðþâàííÿ

̳ñöå â³äáîðó

Ñòàí â³äõîäó (ô³çè÷íèé, àãðåãàòíèé)

Òèï â³äõîäó

Ãëèáèíà â³äáîðó,
ì

Ïîêàçíèê

³äîìîñò³ ïðî ÌÂÂ
(øèôð òà ïîõèáêà âèì³ðþâàííÿ*,
Ð = 0,95)

íàçâà

ïîçíà÷åííÿ îäèíèö³ âèì³ðþâàííÿ

ðåçóëüòàò âèì³ðþâàííÿ

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____________
* Ïîçíà÷åííÿ òà íàçâà ïîõèáêè âèì³ðþâàííÿ.

Íà÷àëüíèê ï³äðîçä³ëó

______________________________________
(ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Âèêîíàâö³

______________________________________
______________________________________
(ïîñàäè, ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

 

Ñòîð. ___, âñüîãî ñòîð. ____

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÀÊÒ
â³äáîðó ïðîá ´ðóíò³â

â³ä "___" ____________ ____ ð.

N ________

ì. ___________________

Íàìè, _______________________________________________________________________________
                                                                             (ïîñàäè, ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________,
â ïðèñóòíîñò³ ïðåäñòàâíèê³â ____________________________________________________________
                                                 (íàéìåíóâàííÿ ñóá'ºêò³â ãîñïîäàðþâàííÿ, ïîñàäè, ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
ç ìåòîþ ______________________________________________________________________________
_____________________________________________________________________________________
íà âèêîíàííÿ _________________________________________________________________________
_____________________________________________________________________________________
âèêîíàíî â³äá³ð ïðîá ´ðóíò³â
íà òåðèòî𳿠__________________________________________________________________________
                                            (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, â³äîì÷à ï³äïîðÿäêîâàí³ñòü, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
(ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí êåð³âíèêà ñóá'ºêòà ãîñïîäàðþâàííÿ àáî çåìëåêîðèñòóâà÷à/çåìëåâëàñíèêà)
____________________________________________________________________________________.
(ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí â³äïîâ³äàëüíîãî çà ïðèðîäîîõîðîííó ä³ÿëüí³ñòü ñóá'ºêòà ãîñïîäàðþâàííÿ)

1. ³äá³ð ïðîá ïðîâåäåíî â³äïîâ³äíî äî âèìîã _____________________________________________
                                                                                                                                    (íàçâà íîðìàòèâíèõ äîêóìåíò³â)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

2. Çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (äàë³ - ÇÂÒ) òà äîïîì³æíå îáëàäíàííÿ, ùî çàñòîñîâóâàëèñü ïðè â³äáîð³ ïðîá __________________________________________________________________________
                                                             (íàçâà ÇÂÒ òà îáëàäíàííÿ, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó ÇÂÒ)
_____________________________________________________________________________________

3 Ïðîáè óïàêîâàí³ â ___________________________________________________________________
                                                                                                          (ïîë³åòèëåíîâ³ ïàêåòè òîùî)

4. Ïàñïîðò ïðîáè                                                            Àêò â³äáîðó ïðîá ´ðóíò³â â³ä ____________ N _______________, àðê. ______ (ñòîð. ______)

Íîìåð ïðîáè

Äàòà, ÷àñ â³äáîðó

̳ñöå â³äáîðó, ïðèâ'ÿçêà äî ì³ñöåâîñò³

Ïëîùà çåìåëüíî¿ ä³ëÿíêè, ì2

Ïëîùà ïðîáíî¿ ïëîùàäêè, ì2

Âèä ïðîáè
(òî÷êîâà, îá'ºäíàíà)

ʳëüê³ñòü òî÷êîâèõ ïðîá

Ãëèáèíà â³äáîðó,
ì

Ìàñà ïðîáè,
êã

Ïîêàçíèêè, ùî ï³äëÿãàþòü âèì³ðþâàííþ

Ïðèì³òêà

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5. Äîäàòêîâ³ â³äîìîñò³ ñòîñîâíî óìîâ â³äáîðó òà â³ä³áðàíèõ ïðîá:

5.1. Ìåòåîðîëîã³÷í³ ñïîñòåðåæåííÿ â³äáîðó __________________________________________________________________________________;

5.2. ²íøå ________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________.

Äî Àêòà â³äáîðó ïðîá ´ðóíò³â äîäàþòüñÿ: ____________________________________________________________________________________
                                                                                                                                                                            (íîìåð òà íàçâà äîäàòêà(³â))

_________________________________________________________________________________________________________________________

Àêò ç äîäàòêîì(àìè): _______________ ñêëàäåíî íà _____ àðê. ó _____ ïðèì., ó òîìó ÷èñë³ äîäàòîê(è) íà _____ àðê.
                                                 (íîìåð äîäàòê³â)

Âèêîíàâö³
â³äáîðó ïðîá

_______________________________
_______________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðåäñòàâíèêè

_____________________________
_____________________________
_____________________________
(íàéìåíóâàííÿ ñóá'ºêò³â ãîñïîäàðþâàííÿ)

___________________________
___________________________
__________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðîáè äîñòàâëåí³ äëÿ ïðîâåäåííÿ âèì³ðþâàíü _______________________________________________________________________________
                                                                                                                                                                                             (äàòà, ÷àñ)

Çàóâàæåííÿ ùîäî ñòàíó ïðîá ³ çàïèñ³â ______________________________________________________________________________________

Âèñíîâîê ùîäî ïðèäàòíîñò³ ïðîá äëÿ ïðîâåäåííÿ âèì³ðþâàíü:

1. Ïðèäàòí³ âñ³ ïðîáè _____________________________________

2. Íå ïðèäàòí³ ïðîáè N ______________________________________             ____________________________________________________
                                                                                                                                                                                                                            (ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî

 

  

ÓÊÐÀ¯ÍÀ

ÄÅÐÆÀÂÍÀ ÅÊÎËÎò×ÍÀ ²ÍÑÏÅÊÖ²ß ÓÊÐÀ¯ÍÈ

________________________________________
(íàéìåíóâàííÿ òåðèòîð³àëüíîãî îðãàíó)

__________________________
(ì³ñöåçíàõîäæåííÿ óñòàíîâè)

 

Òåëåôîí ________________

ÀÊÒ
â³äáîðó ïðîá â³äõîä³â

â³ä "___" ____________ ____ ð.

N ________

ì. ___________________

Íàìè, _______________________________________________________________________________
                                                                           (ïîñàäè, ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________,
â ïðèñóòíîñò³ ïðåäñòàâíèê³â ____________________________________________________________
                                                           (íàéìåíóâàííÿ ñóá'ºêò³â ãîñïîäàðþâàííÿ, ïîñàäè, ïð³çâèùà, ³ìåíà, ïî áàòüêîâ³, òåëåôîíè)
_____________________________________________________________________________________
_____________________________________________________________________________________
ç ìåòîþ ______________________________________________________________________________
_____________________________________________________________________________________
íà âèêîíàííÿ _________________________________________________________________________
_____________________________________________________________________________________
âèêîíàíî â³äá³ð ïðîá â³äõîä³â
_____________________________________________________________________________________
                                  (íàéìåíóâàííÿ ñóá'ºêòà ãîñïîäàðþâàííÿ, â³äîì÷à ï³äïîðÿäêîâàí³ñòü, ì³ñöåçíàõîäæåííÿ)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
(ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí êåð³âíèêà ñóá'ºêòà ãîñïîäàðþâàííÿ àáî çåìëåêîðèñòóâà÷à/çåìëåâëàñíèêà)
_____________________________________________________________________________________
(ïîñàäà, ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³, òåëåôîí â³äïîâ³äàëüíîãî çà ïðèðîäîîõîðîííó ä³ÿëüí³ñòü ñóá'ºêòà ãîñïîäàðþâàííÿ)

1. ³äá³ð ïðîá ïðîâåäåíî â³äïîâ³äíî äî âèìîã _____________________________________________
                                                                                                                                      (íàçâà íîðìàòèâíèõ äîêóìåíò³â)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

2. Çàñîáè âèì³ðþâàëüíî¿ òåõí³êè (äàë³ - ÇÂÒ) òà äîïîì³æíå îáëàäíàííÿ, ùî çàñòîñîâóâàëèñü ïðè â³äáîð³ ïðîá __________________________________________________________________________
                                                            (íàçâà ÇÂÒ òà îáëàäíàííÿ, çàâîäñüêèé íîìåð, â³äîìîñò³ ïðî ïîâ³ðêó ÇÂÒ)

3. Ïðîáè óïàêîâàí³ â ___________________________________________________________________
                                                                                                                    (ïîë³åòèëåíîâ³ ïàêåòè òîùî)

4. Ïàñïîðò ïðîáè                                                               Àêò â³äáîðó ïðîá â³äõîä³â â³ä ____________ N _______________, àðê. ______ (ñòîð. ____)

Íîìåð ïðîáè

Äàòà, ÷àñ â³äáîðó

̳ñöå â³äáîðó, ïðèâ'ÿçêà äî ì³ñöåâîñò³

Ñòàí â³äõîäó (ô³çè÷íèé, àãðåãàòíèé)

Òèï â³äõîäó

Âèä ïðîáè (òî÷êîâà, îá'ºäíàíà)

ʳëüê³ñòü òî÷êîâèõ ïðîá

Ãëèáèíà â³äáîðó,
ì

Ìàñà ïðîáè,
êã

Ïîêàçíèêè, ùî ï³äëÿãàþòü âèì³ðþâàííþ

Ïðèì³òêà

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5. Äîäàòêîâ³ â³äîìîñò³ ñòîñîâíî óìîâ â³äáîðó òà â³ä³áðàíèõ ïðîá:

5.1. Ìåòåîðîëîã³÷í³ ñïîñòåðåæåííÿ â³äáîðó __________________________________________________________________________________

5.2. ²íøå ________________________________________________________________________________________________________________;
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________.

Äî Àêòà â³äáîðó ïðîá â³äõîä³â äîäàþòüñÿ: ____________________________________________________________________________________
                                                                                                                                                                                (íîìåð òà íàçâà äîäàòêà(³â))
_________________________________________________________________________________________________________________________

Àêò ç äîäàòêîì(àìè): ______________ ñêëàäåíî íà _____ àðê. ó _____ ïðèì., ó òîìó ÷èñë³ äîäàòîê(è) íà _____ àðê.
                                                    (íîìåð äîäàòê³â)

Âèêîíàâö³
â³äáîðó ïðîá

_______________________________
_______________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðåäñòàâíèêè

_____________________________
_____________________________
_____________________________
(íàéìåíóâàííÿ ñóá'ºêò³â ãîñïîäàðþâàííÿ)

___________________________
___________________________
__________________________
(ï³äïèñè, ïð³çâèùà òà ³í³ö³àëè)

Ïðîáè äîñòàâëåí³ äëÿ ïðîâåäåííÿ âèì³ðþâàíü _______________________________________________________________________________
                                                                                                                                                                                               (äàòà, ÷àñ)

Çàóâàæåííÿ ùîäî ñòàíó ïðîá ³ çàïèñ³â ______________________________________________________________________________________

Âèñíîâîê ùîäî ïðèäàòíîñò³ ïðîá äëÿ ïðîâåäåííÿ âèì³ðþâàíü:

1. Ïðèäàòí³ âñ³ ïðîáè     _____________________________________

2. Íå ïðèäàòí³ ïðîáè N ______________________________________             ____________________________________________________
                                                                                                                                                                                                                       (ï³äïèñ, ïð³çâèùå òà ³í³ö³àëè)

 

Çàñòóïíèê äèðåêòîðà
Þðèäè÷íîãî äåïàðòàìåíòó

Â. À. Áó÷êî


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