5900-27 RadNet Air Particulate Report

OMB Control No. 2060-0015

Approval Expires XX/XX/XX

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY NATIONAL AIR AND RADIATION ENVIRONMENTAL LABORATORY 540 SOUTH MORRIS AVENUE MONTGOMERY, AL 36115-2601 PHONE: (334) 270-3400 FAX: (334) 270-3454

RADNET AIR PARTICULATE REPORT

FOR USE BY NAREL PERSONNEL ONLY

S AMPLE ID: RAN - DATE RECEIVED:

C OMMENTS:

SAMPLE INFORMATION

1. STATION NUMBER: LOCATION: (city, state)

2. DATE OF COLLECTION:

3. STATION OPERATOR:

4. STATION OPRATORS TELEPHONE:

5. COMMENTS:

AIR SAMPLING DATA

6. SAMPLE START TIME (month/day/year): ________________________ (hr: min)___________:__________

7. SAMPLE STOP TIME (month/day/year): ____________________________________ (hr: min)___________:__________

8. DURATION (hr: min: sec): _______: ________: ________

9. AVG AIR FLOW (m³/hr): _______________

10. AIR VOLUME (m³) ____________________

FIELD ESTIMATE CALCULATION (Must wait 5 hours from time sample is collected to perform field estimate)

11. FIELD ESTIMATE DATE/TIME (month/day/year):____________________________ (hr: min)_______:_______

12. STANDARD ACTIVITY (pCi): ____________________

13. STANDARD GROSS CPM: ______________________ 16. SAMPLE GROSS CPM: ___________________

14. BACKGROUND CPM: __________________________ 17. BACKGROUND CPM: _____________________

15. STANDARD NET CPM: _________________________ 18. SAMPLE NET CPM: ______________________

19. GROSS BETA FIELD ESTIMATE CALCULATION

______________________×_____________________÷________________÷___________________=_______________________

Sample Net CPM Standard Activity (pCi) Air Volume (m³) Standard Net CPM Field Estimate (pCi/m³)

__________________________________

OPERATOR SIGNATURE DATE

C omments:

The public reporting and recordkeeping burden for this collection of information is estimated to average 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed [form or survey] to this address.

EPA Form 5900-27