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Chimney or Other Vertical Draft Source? <br /> Yes <br /> No <br /> Building Slab <br /> Large Slab Penetrations (> 1 Foot Diameter): <br /> Sump <br /> Elevator Shaft <br /> Floor Drain <br /> Other <br /> None <br /> Soil Type 0 to 3 Feet Below Building: <br /> Fine <br /> Coarse <br /> Fine and Coarse <br /> Unknown <br /> Evidence of moisture intrusion from Below Slab? <br /> Yes <br /> No <br /> N/A <br /> Building Windows <br /> Weather Sealed Windows and Exterior Doors? <br /> All Sealed <br /> Some Sealed <br /> None Sealed <br /> Unknown <br /> Ventilation During Sampling: <br /> Open Windows <br /> Closed Windows <br /> Some Windows Open <br /> Building Crawl Space <br /> Evidence of moisture intrusion into Crawl Space from Soil? <br /> Yes <br /> No <br /> N/A <br /> Building Basement <br /> Exposed Basement above grade? <br /> Yes <br /> Building Survey Form Page 7 <br />