-

Sampled By and Sample Date

Comments (continue on back if needed)

Purchase Order Information (if applicable)

System Information

For Trace Use Only

6

5

4

3 Sampling Media Identification

Rush Analysis Request2

1 Contact Information

PLEASE NOTE

• Sample Shelf Life - Return to lab within 15 DAYS• Shelf Life - Sampling Media (Filters, Charcoal Tube, and DetectorTubes) See Exp Date on Return Box* AQ Specification/Other Gases - See Notebook FAQs 4.0 or call topreschedule

MONTH DAY YEAR

Submittal of this air sample authorizes Trace Analytics, LLC to provideservices. If purchase order number is required by your company, pleaseprovide with sample. I attest that all information provided on this datasheet istruthful and accurate to the best of my knowledge.

PRINT Name (Person taking the test)

SIGNATURE

Collection Point:

Other Reference:

Select ISO 8573-1:2010 classes or write in Other Specification

PARTICLE CLASS Class 1 thru 7 or baseline ______________WATER CLASS Class 1 thru 6 or baseline ______________OIL CLASS Class 1 thru 4 or baseline ______________OTHER GASES* ___ ISO 8573-6* ___ Routine

___ Other, must be pre-arranged with Trace

Trace Analytics, LLC15768 Hamilton Pool RoadAustin, Texas 78738800-AIR-1024 or 512-263-0000 • Fax: 512-263-0002E-mail: ServiceTeam@AirCheckLab.com

AIR QUALITY SPECIFICATION*

TYPE OF PURIFICATION INSTALLEDMolecular Sieve/DesiccantRefrigerated DryerNo Dryer

No PurificationUnknown

45 Days120 Days

MonthlyOther

Semi-AnnualStartup

AIR SOURCE IDENTIFICATION:

Filter Number:

Flow Rate: LPM

Sample Time: MINUTES

Ambient Temperature: °F

Ambient Pressure: PSIA

FILTER TEST (FILTER MUST BE RETURNED FOR ANALYSIS)

Source Bottle Number:

OTHER GAS TEST (BOTTLE MUST BE RETURNED FOR ANALYSIS)

Detector Tube Reading:

WATER VAPOR TEST (TUBE MUST BE RETURNED FOR ANALYSIS)

1-5 LPM Flow Rate: LPM

Sample Time: MINUTES

Sampling Point Pressure PSIG

Type Tube Used: 20/a-P 5/a-P

Scale for 20a/-P Tube: (0-250) (0-500) (0-1500)

Charcoal Tube Number:

Flow Rate: LPM

Sample Time: MINUTES

OIL VAPOR TEST (TUBE MUST BE RETURNED FOR ANALYSIS)

Charcoal Tube Number:

CHARCOAL BLANK, INCLUDE WITH EACH BATCH

WRITE "NOT APPLICABLE OR N/A" FOR EACH TEST NOT TAKENPO Number: PO Valid Thru:

TESTING FREQUENCY

7

0 - 1500

ISO AirCheck DataSheet™

CAREFULLY PRINT ALL INFORMATION AND RETURN A COPY WITH EACH SAMPLE SET.IF ANY OF THE PREPRINTED INFORMATION IN THE BOXES IS INCORRECT, MARK THROUGH AND CORRECT.

© Copyright 2012, Trace Analytics, LLC

By marking this box, I understand that I am authorizing 1 Workday Analysis & Reporting for an additional $150 per sample. Initial here:

IMPORTANT: PLEASE CALL 1–800–247–1024 (ext. 2) or 1–512–263–0000 (ext. 2) TO SCHEDULE

RUSH

✓

Receiving I.D.

Receiver’s Initials

Filter Number:

FILTER BLANK, INCLUDE IF APPLICABLE

Contact Phone FaxE-mail

Alternate Phone FaxE-mail

www.AirCheckLab.com We Do One Thing –Test Compressed Air

Print or Create PDF

To the Core

Please check box to the left if you'd like the AirCheck√ Report sent to the person below (fill in information).

Contact E-mail

Customer ID Customer Name Country

SAMPLED FOR:

AnnualBimonthly

QuarterlyRandom Sample

VerificationWeekly

ISO 8573-1:2010 CONTAMINANTS AND PURITY CLASSES

Note 1: ISO 8573 Oil includes aerosol, vapor and liquid oil. Liquid oil is typically sampled when wall flowis present, contamination is suspected, or results are greater than 5 mg/m3.

Note 2: For Particle Class 1 & 2 (0.1 - 0.5 micron range only), if requested prior to sampling, appropriatesampling media can be provided for collection and submittal to a 3rd party laboratory.

In some cases, Trace uses alternative sampling techniques or analytical methods to those specified inISO 8573, for details see Smith White Paper, 2012.

ISO standards are copyrighted and can be purchased at ANSI's web site:

http://webstore.ansi.org

0

400 10 — ≤ –70 ≤ –94 — ≤ 0.011

400,000 6,000 100 — ≤ –40 ≤ –40 — ≤ 0.12

— 90,000 1,000 — ≤ –20 ≤ – 4 — ≤ 13

— — 10,000 — ≤ + 3 ≤ +37 — ≤ 54

— — 100,000 ≤ + 7 ≤ +45 — —5

— — — ≤ +10 ≤ +50 — —6

— — — 5 — 10 — — 0.5 —7

— — — — — — 5 —8

— — — — — — 10 —9

— — — > 10 — — > 10 > 5X

20,000

0 — 5

As specified by the equipment user or supplier and more stringent than class 1

Shaded areas indicate classes for which Trace Analytics methods apply.Others require techniques outside of Trace Analytics scope. See Note 2.

0.5 – 1micron

1 – 5micron mg/m3 °F g/m3 mg/m3

0.1 – 0.5micron °C

CLASS

By Particle Sizemaximum number of particles per m3

By Mass

ParticlesAerosol& Vapor

Oil1

Vapor

Pressure Dewpoint

Liquid

Water

ISO AirCheck DataSheet™✓

www.AirCheckLab.com We Do One Thing –Test Compressed Air