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DATA SHEET
STATION
CITY

_STATE

TAKEN BY
Start Sample -— Date

Hour

Time Zone

End Sample

Hour

Time Zone

- Date

Wind Direction

Velocity

Weather Conditions

C7? Precipitation
Estimated Volume Collected

pints

Estimated Rainfall

inches

Duration, from

to

(__) Settled Dust on Tray
[3 Settled Dust on Gummed Paper

(““)] Airborne Dust
Sampling Rate, start

finish

rt°/min.

General Remarks

Counting Data:

Time of Counting - Date

Hour.t“(‘ClTime «Zone

Total Count

min,

Counting Period

Gross Rate

c/m

Background

c/m

Net Rate

c/m

Results

d/m/sample

c/d

Efficiency Factor

d/m

(unit)
Final Extrapolated Value

(unit)
Time Zone

Extrapolated to - Date

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