<p> ASBESTOS FIBER COUNTING FORM</p><p>Laboratory: ______Laboratory Address: ______Laboratory POC: ______Laboratory Telephone Number: ______</p><p>SAMPLE COLLECTION INFORMATION: LABORATORY METHOD INFORMATION: Lab Report No. ______Method: NIOSH 7400, 15 Aug 1994, Rules: A Lab Sample ID No. ______Reticle: Walton Beckett Field Sample ID No. ______Microscope: Olympus CH-2 Sample Air Volume: (L) ______Counting Field Area : 0.00785 mm2 Filter Size (mm) : ______25 mm Effective Collection Area : 385 mm2 Limit of Quantitation (LOQ) : 7 fibers/mm2 FIBER COUNTS/FIELD 1 21 41 61 81 SAMPLE: 2 22 42 62 82 Total Fiber Count: ______3 23 43 63 83 Number of Fields: ______4 24 44 64 84 5 25 45 65 85 Fibers per Field: ______6 26 46 66 86 7 27 47 67 87 AVERAGE BLANK COUNT: 8 28 48 68 88 Total Fiber Count for All Blanks: ______9 29 49 69 89 10 30 50 70 90 Total Number of Fields: ______11 31 51 71 91 Average Fibers per Field:______12 32 52 72 92 13 33 53 73 93 NET FIBER COUNT: ______fibers/field 14 34 54 74 94 Subtract average blank count from sample count 15 35 55 75 95 16 36 56 76 96 17 37 57 77 97 CALCULATIONS: 18 38 58 78 98 Perform calculations and report the following: 19 39 59 79 99 20 40 60 80 100</p><p>______fibers/mm2 2 FIBERS/mm = (Net Fiber Count) = ( fibers/field) = (Counting Field Area) ( 0.00785mm2 )</p><p>2 2 AIRBORNE ASBESTOS = ( Fibers/ mm )( 385 mm ) = ______fibers/cc CONCENTRATION ( Volume L)( 1000 cc/L) </p><p>Performed by: ______Analysis Date: ______</p><p>Reviewed by: ______Review Date: ______</p><p>CIHL Form 005 1/02 Originally Developed By: San Diego CIHL</p>