NYC 9/11 Public Portal Document
****DRAFT Version 10, October 29, 2001****
VIII. Information Needs for Samples/Sample Locations:
In order to interpret results, the following information should accompany each area sampled;
A. Sample Collection Assessment Form
1. Description of reason for selection of site for sampling (e.g., apartment had windows open or
broken during the WTC event; visible dust present in ambient air adjacent to apartment building)
Occupied residence
Unoccupied residence
Common area
Justification for sample location (describe):
2. Physical address
3. Apartment/floor number/common area location
4. Contact Phone #
5. Side of building (N, S, E, W)
6. Is visible dust present (air, surfaces)
Yes No
TTYES, describe
7. Was HVAC fan in operation during entire sampling event?
Yes No
TTNO, how WS5 the fan running (hrs.):
8. For surface dust sampling, measurement of area sampled (square meters or square feet)
9. Sketch of area showing air and surface dust sample location"
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