1、(TO BE SUBSTITUTED BEARING SAME NO. otherwise priority would be given to next farmer.Date: Signature of Farmer Signature of ADO _SENIORITY SLIPName of Farmer :Seniority No. as per Roster Register :Telephone/Mobile No. of ADO : Date: Signature of ADOAnnexure-IISAMPLING PERFORMA Testing of HDPE IS: 14
2、151 (Part-I & II) and PVC IS:49851. Sample Code No. :2. Type of Sample Pipe (HDPE/PVC) :3. System (UGPL/Sprinkler) :4. Side sample (SS)/Factory sample (FS) : 5. Name of farmer with address :6. Date of sampling :7. Size of pipes :(1m for HDPE & 1.5 m for PVC)8. Pressure Class of Pipe : (2.5kg./cm2/3.
3、2kg./cm2 /4.0 kg./cm2)9. Test Required : Quality TestName & Signature Name & Signature Name & Signature (Representative of the firm) (Farmer) (ADO/AI) Name & Signature (Sample Drawing Officer with Designation & Seal) Annexure-IIIPERFORMA FOR RELEASE OF SUBSIDY (SPRINKLER)1. Name of Farmer :2. Father
4、s/Husband Name :3. Village :4. Block :5. District :6. Name of Firm :7. Area Covered (ha) : 8. ISI Marked on Pipes (Yes/No) :9. Length (m)/ No. of Pipes :10. Year of Installation :11. Total Cost (Rs.) :12. Amount of Subsidy (Rs.) :13. Consent with Affidavit for :release of subsidy to the Manufacturer (Yes/No)Remarks: Certified that the above information is furnished by me and I am fully satisfied with the installation & working of Sprinkler system laid in my field.(Signature of Farmer)Witness: Name Signature1.2.
