FORM 4
EP 1110-1-28
RISK ASSESSMENT DUST WIPE SAMPLING FORM
31 Aug 01
(Single Surface Sampling)
(Note: Attach a Copy of the Chain-of-Custody Form to this Form. See Lab Report for
QA/QC Information.)
NOTES:
Name of Risk Assessor (print)
Certification Number(s)
Signature
Date
Figure
B-4:
Risk
Assessment
Dust
Wipe
Sampling
Form
B-16
Previous Page
