Air Emissions Sampling Report

1. Facility Information

Facility Name Location Contact Person Date of Sampling

2. Source Details

Emission Point ID Description of Source Process Description

3. Sampling Methodology

Reference Method(s) Used Sampling Duration Sampled Parameters Equipment Used

4. Results

Parameter	Result	Units	Detection Limit

5. Observations & Notes

Field Observations Comments

6. Personnel

Names of Sample Collectors Report Prepared By

7. Attachments

Supporting Documents / Photos