National
Radon Proficiency Program
PO Box 2109
Fletcher, NC 28732
angel@neha-nrpp.org
www.radongas.org
Chamber Application
| Company Name: |
| Street Address: |
| City, State, Zip or Postal Code: |
| Name of Responsible Party: |
| Telephone Number: ( ) |
| Fax Number: ( ) |
| Email Address: |
| Type of performance tests services to be provided: Radon: ___ Short-term: ___ Long-term: ___ Radon decay products: ___ |
The following information or affirmation is to be provided with the application prior to participation in the intercomparison.
Item |
Reference Item in Chamber Protocols |
Reference Item in Chamber App. Instructions |
Initials |
| Quality Assurance Quality Control plan | 1.2 |
||
| Standard Operating Procedure | 1.2 |
||
| Commercial radium source Supplier name: ____________________________ |
1.3 |
||
| Chamber Indicate size: __________________ cubic feet |
1.4 |
||
| Chamber continuous measurement device Attach description and calibration information |
1.4.6 |
||
| Chamber grab measurement device Attach description and calibration information |
1.4.6, 1.5.2.1 |
||
| Copy of Responsible Partys NEHA certification as a Residential Measurement Service Provider | 1.6.4 |
||
| Statement of potential conflicts of interest | 1.6 and/or 2.6 |
||
| Signature page | 7 |
||
| Statement of agreement to follow chamber protocols or provision of proposed revisions | 2 |
||
| Non-refundable application processing fee of $600 | 6 |
The following materials must be provided prior to approval.
Item |
Reference Item in Chamber Protocols |
Reference Item in Chamber App. Instructions |
Initials |
Certificate(s) of insurance indicating additionally insured parties |
4 |
||
Proof of passage of intercomparison |
2.1 |
||
Sample form letter for notifying participants of need for performance testing |
3.1 |
||
Sample failure letter of performance test |
3.2 |
||
Sample passage letter of performance test |
3.2 |
||
Sample database file (electronic and paper) |
3.2 |
||
Performance test pricing schedule |
6 |
||
Certification fee of $350 |
6 |
| Signature of Responsible Party: Date: |