EMBLEM FORM 'J' [See Clause 28(1)(b)] Form Indicating particulars of Fertiliser Sampled 1. Name & Address of dealer/manufacturer [/importer]........... 2. Date of sampling .......................... 3. Details of making on bags from where sample has been taken (I) Type & grade of fertiliser with brand ........................... (ii) Name of the manufacturers [/importers] ....................... (iii) Registration No. ........................................................... (iv) Lot No. & date of manufacture [/import] ................ (v) Composition ................................................................. 4. Date of receipt of the stock by the dealer/manufacturer, [/importer] / pool handling agency................................................... 5. Serial No./Code No. of sample ..................................................... 6. Stock position of the lot ................................................................ 7. Physical condition of fertiliser ...................................................... 8. Whether samples drawn from open bags or stitched bags ............ 9. Name & Address of Fertiliser Inspector drawing sample .............. Signature & Metallic Seal impression of Fertiliser Inspector. RECEIPT OF THE DEALER Certified that the sample of fertiliser has been drawn in accordance with the procedure laid down in the Fertiliser (Control) Order, 1985 from the stock in my possession, and I have signed the test samples at the time of wax sealing. I have also received one test sample our of the three test samples prepared. Signature of dealer/manufacturer/ pool handling agency with address
