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SAMPLE E O TIME TIME VOLUME CASSETTE O
TYPE LOCATION BEF. AFTER PER PER LAB ID# o
ID# S R IN OUT (lilflrs) 25MM 37MM o
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DATE OF ANALYSIS:
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TIME OF ANALYSIS;
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SAMPLE TYPE: A=BACKGROUND. B=PREABATEMENT. C=DURING ABATEMENT, D=POST-ABATEMENT
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K E=OUTSIDE WORK AREA, F=INSIDE WORK AREA. G=MICROTRAP EXHAUST DISCHARGE SB
I H=DECONTAMINATION FACILITY. I=CRITICAL BARRIER, J=OUTSIDE BL 'FIELD BLANK
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o TYPE OF RESPIRATORS
AIR QUALITY, M=COMPLIANCE MONITORING
= HALF FACE, 2 = PAPR, 3 = TYPE C, 4 = OTHER (SPECIFY)
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o TYPE Of* WORK: 1= BLDG DECON, 2 = PLASTICIZING. 3 = GROSS REMOVAL, 4 = GLOVEDAG. 5 = CLEANING,
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I 6 = ENCAPSULATION, 7 = BAGOUT, 8 = OTHER (SPECIFY):
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ECHNICIAN: Tl ROTAMETER: —Z? pageJ? of 5
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