5900-30 RadNet Air Particulate Sample 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

AIR PARTICULATE SAMPLE REPORT

THIS SECTION FOR USE BY NAREL PERSONNEL ONLY

SAMPLE ID: RAN - ____________________ DATE RECEIVED: ______________________

C OMMENTS: _____

SAMPLE INFORMATION

STATION NUMBER: _______ LOCATION: ___________________________________________

DATE/TIME OF COLLECTION (Coordinated Universal Time): _______________________________

NAME OF STATION OPERATOR: ____________________________________________________

STATION OPERATOR’S TELEPHONE NUMBER: _______________________________________

COMMENTS: ____________________________________________________________________

_ _______________________________________________________________________________

AIR SAMPLING DATA

SAMPLE START DATE/TIME (Coordinated Universal Time): _______________________________

SAMPLE STOP DATE/TIME (Coordinated Universal Time): ________________________________

TOTAL SAMPLE TIME (hours): ______________ SAMPLE VOLUME (m³): __________________

A VERAGE SAMPLE FLOW RATE (m³/hour): ___________________________________________

FIELD ACTIVITY CALCULATION

MEASUREMENT DATE/TIME (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 _________ (pCi/cpm)

ALPHA ACTIVITY: pCi BETA ACTIVITY: _________ pCi

SAMPLE VOLUME: ∕__________ m³ SAMPLE VOLUME: ∕__________ m³

α CONCENTRATION __________ pCi/m³ β CONCENTRATION __________ pCi/m³

β ∕ α RATIO: __________

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 5900-30