5900-24 Air Particulate Sample Report

OMB Control No. 2060-0015
Approval Expires ##/##/####

AIR PARTICULATE SAMPLE REPORT
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
NATIONAL ANALYTICAL RADIATION ENVIRONMENTAL LABORATORY
540 SOUTH MORRIS AVENUE
MONTGOMERY, AL 36115-2601
Tracking Environmental Radiation Nationwide
PHONE: (334) 270-3400

RadNet
Net

THIS SECTION FOR USE BY NAREL PERSONNEL ONLY
SAMPLE ID: RAN-____________________
Comments:

DATE RECEIVED:____________________

_____________________________________________________________

STATION INFORMATION
STATION NUMBER : _______________

LOCATION: _________________________

NAME OF STATION OPERATOR: ________________________________________________
CONTACT INFORMATION (phone or email): ________________________________________
Comments:

________________________________________________________________
________________________________________________________________

SAMPLE DATA
UTC SAMPLING START date & time (Coordinated Universal Time):

_____________ ___:___

UTC MEASUREMENT STOP date & time (Coordinated Universal Time): _____________ ___:___
STP TOTAL SAMPLING VOLUME [m3]: ___________________ m3

If sample collected on a date different than “UTC MEASUREMENT STOP” date
then please record sample collection date here: _________________________
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. OMB 2060-0015. Responses to this
collection of information are voluntary. 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 recordkeeping burden for this collection of information is estimated
to 7-20 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 5900-24