Form 5900-23 RadNet Equipment and Supply Request Form

RadNet Drinking Water Report
United States Environmental Protection Agency
National Air aDd Radiation Environmental Laboratory
540 South Morris Avenue
Montgomery, AL 36115-2601
Telephone: (334) 270-3400
Facsimile: (334) 270-3454

1. Date of Collection:

2. Quarter:(CIRCLEONE) Jan-Mar Apr-Jun Jul-Sep Oct-Dee Year:
3.
4.
5.
6.

Station (City,State):
Tap Location:
Name of Collector:
Office Address:

7. Shipping Address:
8. Telephone:
10. Comments:

o

9. . Fascimile:

Please check here if reporting change of address or collector.
(CIRCLE ONE)

The following is provided in accordance with the Paperwork Reduction Act. Public reporting burden for this
collection of information is estimated to vary from .58 to 1.35 hours per response, depending on media type collected
with an average of 1.08 hours per response, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate or any other aspect, including suggestions for reducing this burden to the
laboratory director at the above address and to the Office of Information and Regulatory Affairs, Office of Management
and Budget, Washington, DC 20503.
rss: 02/06/06

r
I

.

ERAMS Pasteurized Milk Report

United States Environmental Protection Agency
N~tional Air and Radiation Environmental Laboratory
..

540 South Morris Avenue

Montgomery, AL 36115-2601
Telephone: (334) 270-3400
Facsimile: (334) 270-3454

1. Date of Collection:
2. Quarter:

Jan-Mar

Apr-June

Jul-Sept

Oct-Dee

Year:

3. Principal City:
4. Name of Collector:
5. Address of Collector:

6. Telephone Number of Collector:
7. Facsimile Number of Collector:
8. EPABottle Number:
9. Names of Contributing PlantsIDairies:
10. Specify pounds or gallons produced per day on the sample collection date by the contributing
I

plants/dairies:

I

11. Comments:

o Please check here if reporting change of address or collector.
The following is provided in accordance with the Paperwork Reduction Act. Public reporting burden for
this collection of infonnation is estimated to vary from .58 to 1.35 hours per response, depending on media type
collected with an average of 1.08 hours per response, including time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
infonnation. Send comments regarding the burden estimate or any other aspect, including suggestions for
reducing this burden to the laboratory director at the address above and to the Office of Infonnation and Regulatory
Affairs, Office of Management and Budget, Washington, DC 20503.
rss:03/25/99

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I

AIR PARTICULATE SAMPLE REPORT
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
NATIONAL AIR AND RADIATION ENVIRONMENTAL
LABORATORY
540 SOUTH MORRIS AVENUE
MONTGOMERY, Al 36115-2601
PHONE: (334) 270-3400
FACSIMilE: (334) 270-3454

THIS SECTION FOR USE BY NAREL PERSONNEL ONLY
DATE RECEIVED:

SAMPLE ID: RANCOMMENTS:

SAMPLE INFORMATION
STATION NUMBER:

LOCATION:

~

-

DATEfTlME OF COLLECTION (Coordinated Universal Time):
NAME OF STATION OPERATOR:
STATION OPERATOR'S TELEPHONE NUMBER:
COMMENTS:
AIR SAMPLING DATA
SAMPLE START DATErrlME (Coordinated Universal Time):
SAMPLE STOP DATEfTIME (Coordinated Universal Time):
TOTAL SAMPLE TIME (hours):

SAMPLE VOLUME (m3):

AVERAGE SAMPLE FLOW RATE (m3/hourt
FIELD ACTIVITY CALCULATION
MEASUREMENT DATErrlME (Coordinated Universal Time):
GROSS ALPHA/BETA CPM:
BACKGROUND CPM:

-

NET ALPHA/BETA CPM:
ALPHA CPM

ALPHA CPM:

-

NET BETA CPM:
ALPHA EFFICIENCY: X
(pCi/cpm)

BETA EFFICIENCY: X
(pCj/cpm)

ALPHA ACTIVITY:

pCi

SAMPLE VOLUME: I

m3

a CONCENTRATION

___

pCi/m3

BETA ACTIVITY:
SAMPLE VOLUME: I..

p CONCENTRATION

pCi
m3

pCi/m3

pia RATIO:
Version0

October6, 2005

ERAMS AIR AND PRECIPITATIONREPORT
National Air and Radiation Environmental Laboratorv
540 MorrisAvenue.Monlgomery.AL36115
334 270-3400
RA N-

SAMPLE10:

FIRSTCOUNT:
Year

DATE RECEIVED:

Year

Monlh

Hour

GrossCounls

Syslem

_I
Monlh

Lenglh(Mln)

COMMENTS:

SECONDCOUNT:
Year

Monlh

Hour

Day

---GrossCounrs

Lenglh(Mln)

System

(AboveForUseby NARELPersonnelOnly)

1. STATlmJNUMBER

5. TYPE OF SAMPLING:

2. LOCATION:

6. AIR FLOW

STD/DST

3. TIMEZONE:

/

Start
Time

Month

8. AIR VOLUMECALCULATION

START

STOP

m'/hr:

Month

/
Oay

Slep
Time Monlh

Hour

Is air -volume known?

YES

DnTime
SdmplePeriod

(

)

Air
Volume
(m')

YES

Is survey meter operable?

Hour

Oay

Molor
Failure

OUI{CyCle

£ampling
Period
(Hours)

Average
AirFlow
(m'/hr)

mJ/hr.

NO

x

x

1/3
Duly

7. DURATIONOF SAMPLING

4. DATE OF COLLECTION
Year

Continuous
Duly

Filler
Failure

NO

9. FIRSTFIELDESTIMATE
(AIR)
HOURS TO 1st F.E.

x
SampleNET'CPM

STANDARDREADING

SAMPLE READING

Gross
CPM

Gross
CPM

StandardActivity (pCi)

1
Oay

Hour

Bkgd

x

-CPM

SiandardNETCPM

Air Vol. (m')

--

NET
CPM

FIELDESTIMATE
(pCi/m')

Bkgd
CPM
NET
CPM

10. SECOND
FIELDESTIMATE(AIR)
x
SampleNETCPM

HOURS TO 2nd F.E.

Oay

Gross
CPM

Hour

x

Bkgd
CPM

StandardNETCPM

Air Vol. (m')

SAMPLE READING

STANDARDREADING

SiandardActivity (pCI)

NEr
CPM

Gross
CPM

-

Bkgd
CPM
NET
CPM

FIELDESTIMATE
(pCI/m')

11. CALCULATION
OFDEPTHOFPRECIPITATION

PRECIPITATION
(Notetype)

VolumeconecleFile Typeapplication/pdfFile Modified2006-11-30File Created2006-11-30