Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

What type of facility will be tested? (Check all that apply.)

Asphalt         Chemical        Hospital        Pulp Mill     
Aluminum        Electroplate    Incinerator     Quarry        
Boiler(s)       Foundry         IC Engine       Refinery      
Cement          Gas Turbine     Landfill        Vapor Recovery

Which unit(s) are to be tested?

What is the purpose of the testing?

Compliance         Baseline           Engineering Study  

What is the scope of testing?

Particulate  CEMS         Toxics       Opacity    

Are there any date/time restrictrictions on testing?

Under which regulatory agency are the unit(s)?

What is the renewal date on the unit(s) Permit to Operate?

-- mm/dd/yy

May we have a copy of your Permit to Operate?

Yes No

What type of control equipment is present?

Baghouse      ESP           Wet Scrubber  Cogen       

What cross-section are the stack(s)?

Rectangular or Square
Round

What is the stack diameter or length × width? (in)

What is the average stack temperature? (°F)

What is the average stack pressure? (mm. Hg)

Please describe the moisture conditions.

Please describe the flow rate.

What is the pressure differential? (ΔP)

How many sampling ports are present?

What diameter are the sample ports? (in)

If threaded, what gender are the sample ports?

Male
Female
Not Applicable

How deep are the sample ports? (in)

Please describe the sampling platform, access, and electrical availability.

Are there any special safety considerations?

Other comments and questions.