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Indoor Air Source Screen Form This form should be used while conducting field screening (Step 3A.3, Supplemental Vapor Intrusion Guidance). An Indoor Air Source Screen Survey of indoor air will help identify potential sources of vapor forming chemicals (VFCs) and/or potential subsurface vapor entry points. Common screening tools, such as, Photoionization Detector (PID), Gas Chromatography-Photoionization Detector (GC-PID), Gas Chromatography-Mass Spectrometry (GC-MS), or Gas Chromatography-Electron Capture Detector (GC- ECD), should be used to detect the presence of VFCs in the air. Use this form to document the room/area and location where the measurement was recorded during the Indoor Air Source Screen Survey, the field instrument type used, and the instrument reading and units. If a consumer product is identified and surrounding air tested, the location and the volatile ingredients of the product should be noted. (If the item(s) may be contributing VFCs to the indoor air, the items should be removed in advance of indoor air sampling.) This survey should be used to support the development of a conceptual understanding of how vapor intrusion may be occurring at the building and used in selecting sample locations for evaluating spatial distribution of VFCs in indoor air. Site Input Information Building Address: Site/Facility Name: Screening Event Date: Screening Event Time: Event Weather Conditions: Name of Person(s) Conducting Sampling: Company Conducting Sampling: Field Instrument Type' (List All): Instrument Calibration Date: 1 - Photoionization Detector (PID), Gas Chromatography-Photoionization Detector (GC-PID), Gas Chromatography-Mass Spectrometry (GC-MS), Gas Chromatography-Electron Capture Detector (GC- ECD), etc. Indoor Air Source Screen Form Page 1