Sound Monitor Survey Form

                                            Township                                                                   County

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* Dominant wind direction                             *General wind speed:
*Ambient temperature:                *Humidity:                 *Atmospheric Pressure::          *Weather Conditions:
* check if monitoring indoors    Yes ___
Sound Monitoring Equipment -  Sper Scientific Sound Meter, Model # 840029, Certified Calibration
Sound Monitoring Equipment (other) -
Signature of person conducting survey __________________________________Date: ____________

Any former complaints file?   __ Yes   __ No        If so, to whom? ________________________________

(Company Name      /  Representatives Name)
Well site number (if known)  _____________
Location of nearest crossroads if well number is not known   ___________________________________
Complaintee name & address   
Time
Location 
Number
Location 
Decibel 
Reading
 Notes

Nuisance 
Level
. 1 .
dbA
dbC
.. ..
.
2
.
dbA
dbC
. .
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3
..
dbA
dbC
. .
.
4
.
dbA
dbC
. .
.
5
.
dbA
dbC
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6
.
dbA
dbC
. .
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7
.
dbA
dbC
. .
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8
.
dbA
dbC
. .
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