Table #: Sub-lethal effect of {test material} on {test organism} on day x

Treatment (mg/l) nominal (measured) concentration

% deformed larvae

Behavioral effects (specify)

Behavioral effects (specify)

Toxicity symptoms (specify)

Toxicity symptoms (specify)

Control (dilution water only)

Replicate #1

Replicate #2

Solvent control

Replicate #1

Replicate #2

Test concentration 1

Replicate #1

Replicate #2

Test concentration 2

Replicate #1

Replicate #2

Test concentration 3

Replicate #1

Replicate #2

Test concentration n

Replicate #1

Replicate #2