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Appendix D <br /> <br />https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats <br />c-rem3-01a • 1/13/21 Page 7 of 8 <br />Part 3: Indoor air quality survey <br />Complete if indoor air sampling is conducted (use grids in Part 1 for labeling sampling locations). <br />Factors that may influence indoor air quality: <br />Is there an attached garage? Yes No <br />Are petroleum-powered machines or vehicles stored in <br />the garage (e.g., lawn mower, ATV, car)? Yes No Please specify: <br />Has the building ever had a fire? Yes No When: <br />Is a kerosene or unvented gas space heater present? Yes No Where & type: <br />Is there smoking in the building? Yes No How frequently: <br />Have cleaning products been used recently? Yes No When & type: <br />Have cosmetic products been used recently? Yes No When & type: <br />Has painting/staining been done in the last 6 months? Yes No Where & when: <br />Has any remodeling or construction occurred in the last <br />6 months? Yes No Where & when: <br />Is there new carpet, drapes, or other textiles? Yes No Where & when: <br />Have air fresheners been used recently? Yes No When & type: <br /> <br />Is there a clothes dryer? Yes No If yes, is it vented outside: <br />Are there odors in the building? Yes No If yes, please describe: <br /> <br />Do any of the building occupants use solvents at work? Yes No <br />If yes, what types of solvents are used: <br />Do any of the building occupants regularly use or work <br />at a dry -cleaning service? Yes No <br />If yes, indicate approximately how frequent: <br />Product inventory form (Add additional rows if needed) <br />Make and model of field instrument used: Mini-Rae PID, 10.6 eV <br />List specific products identified in the building that have the potential to affect indoor air quality (add or delete rows as needed): <br />Location Product description* Comments <br />Instrument <br />readings if <br />taken and units <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />* Describe the condition of the product containers as unopened (UO), used (U), or deteriorated (D). <br />Include photographs of product containers as appropriate to document products and ingredients. <br />86