N.Y. FORM 107
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(9-10-51)

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Pam

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DATA SHEET
STATION
CITY

STATE

TAKEN BY
Start Sample - Date

Hour

Time Zone

End Sample

Hour

Time Zone

- Date

Velocity

Wind Direction
Weather Conditions

LC! Precipitation
EStimated Vuluine Collected

pints

Estimated Rainfall

Duration,

inches

from

to

(“J Settled Dust on Tray
[] Settled Dust on Gummed Paper

(7) Airborne Dust
Sampling Rate,

finish

start

ft°/min,

General Remarks

Counting Data:

Time of Counting - Date

Hour

Total Count

Time

Zone

Counting Period

Gross Rate

c/m

Background

c/m

Net Rate

c/m

Results

d/m/sample

min,

Efficiency Factor

c/d

d/m

(unit)
Final Extrapolated Value
Extrapolated to - Date

Time

Zone

(Use separate sheet for each sample)

7) pom ARCHIVES %
rn aco

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