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