Form 5800-070 Radon Measurement in US Virgin Islands

OMB Control Number: 2080-0083
Expiration Date: 1/31/2024

OMB Instrument Form
Burden Statement:
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq.
(OMB Control No. 2080-0083). Responses to this collection of information are voluntary (Indoor Radon
Abatement Act of 1988 - Public Law 100-551). An 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. The
public reporting and record keeping burden for this collection of information is estimated to range from 5-10
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 to the Regulatory Support
Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C.
20460. Include the OMB control number in any correspondence. Do not send the completed form to this
address.

EPA Form #:
5800-070

OMB Control Number: 2080-0083
Expiration Date: 1/31/2024

Date Completed
About you and your scientist
Scientist
Homeowner Name
Street Address 1

street number and name

Street Address 2

additional address

Unit Number
City or Town

Virgin Islands

Community

St. Croix

Division

North End

About Your Home
Home Construction Type crawl space pile footings

Additional Home Construction Notes

3/16/22 19:05
Testing Information
Test Type:

Short Term Ground

Short Term Closed Space

Describe:
Detector Placement Information

Detector Placement Date and Time

3/23/22 16:05

Detector Collection Date and Time

3/30/22 16:05

Location In Home normally closed room in living area
Scientist Notes

EPA Form #:
5800-070

Long Term Living Quarters

Other(Describe)