Collect an Ashfall Sample

OMB Control Number: 1028-0106
Expiration Date: May 31, 2016

D ATA COLLECTION SHEET (please print, fill out, and submit with your samples)

A	B	C	D	E	F	G
Sample Number	Date & time of Collection (or duration if applicable)	Location of collection	Dimensions of container	Thickness of ash layer (nearest ½ millimeter)	Describe surface upon which ash has fallen	Describe weather conditions during ash fall, if known

Please send samples and sample datasheet to:

USGS/Alaska Volcano Observatory, 4230 University Drive, Suite 201, Anchorage, AK 99508, 907-786-7497

Collector Contact Information: Name_______________________, Phone ________________, Email_____________________

H. Photos

Please indicate if you give permission to the Alaska Volcano Observatory to use your photographs on their

Webpage __________________________ all photos ____ select photos only____ (please indicate which images).

signature

Please only send copies or digital images as they will not be returned. All photos will be credited to photographer.

PAPERWORK REDUCTION ACT STATEMENT: A Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Public burden for reviewing these instructions is estimated to average 3 minutes per response. Comments regarding this collection of information should be directed to the Bureau Clearance Officer, U.S. Geological Survey, 12201 Sunrise Valley Drive, MS 807, Reston, VA 20192, or call 703-648-7174.