Monitoring
Location |
|
|
Details
of Location |
|
|
Sampler
Identification |
|
|
Date
& Time of Sampling |
|
|
Elapsed-time
Meter Reading |
Start
(min.) |
|
Stop
(min.) |
|
|
Total
Sampling Time (min.) |
|
|
Weather
Conditions |
|
|
Initial
Flow Rate, Qsi |
Pi
(mmHg) |
|
Ti
(°C) |
|
|
Hi
(in.) |
|
|
Qsi
(Std. m3) |
|
|
Final
Flow Rate, Qsf |
Pf
(mmHg) |
|
Tf
(°C) |
|
|
Hf
(in.) |
|
|
Qsf
(Std. m3) |
|
|
Average
Flow Rate (Std. m3) |
|
|
Total
Volume (Std. m3) |
|
|
Filter
/ PUF Cartridge Identification No. |
|
|
For TSP
determination |
|
|
Initial Wt. of Filter (g) |
|
|
Final Wt. of Filter (g) |
|
|
Measured TSP Level (mg/m3) |
|
|
For Dioxin determination |
|
|
Wt. of Dioxin on
PUF Cartidge (pg I-TEQ) |
|
|
Measured Dioxin Level (pg I-TEQ/m3) |
|
|
|
Name & Designation |
|
Signature |
|
Date |
Field
Operator |
: |
|
|
|
|
|
|
|
|
|
|
|
|
Laboratory
Staff |
: |
|
|
|
|
|
|
|
|
|
|
|
|
Checked
by |
: |
|
|
|
|
|
Appendix C Sample Template for
the Interim Notification
Project |
|
Date |
|
Time |
|
Monitoring
Location |
|
Parameter |
|
Action
& Limit Levels |
|
Measured
Level |
|
Possible
reason for Action or Limit Level Non-compliance |
|
Actions
taken/ to be taken |
|
Remarks |
|
Designation : _____________________
Signature : _____________________
Date : _______________