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.Site Safety and Health Plan <br /> Air Monitoring Qatasheet <br /> Job No.: <br /> Date: Monitoring by: Activity/Location: <br /> Instrument Make: Model: Serial No.: Calibration Time: <br /> Personnel Monitored: <br /> Concentration(ppm) <br /> Breathing Sample Respirator <br /> Time Zone Source Other Location Comments Use(Y/N) <br /> Submit copy of this form to the project file. <br /> Submit copy to the Project Health and Safety Office if respiratory protection was required and/or concentrations exceeded respiratory protection <br /> criteria in this SSHP. <br /> Incident Free Operation Page 38 of 68 <br />