appc - CHEMICAL DATA SHEET '" PAGE NO- NO. OF...

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Unformatted text preview: CHEMICAL DATA SHEET '" PAGE NO- NO. OF PAGES MONITORING OF! SURVEY For use of thus form. see FM 3-3; proponent 0! thus 1mm I3 TRADOC. UNiT ON: OR OR 3 a E EA EMBER (Pram Name) MONITOR OR SURVEY TEAM NUMBER MAP USED 77 Hui LOCATION/TIME TYPE DETECTOR USED AGENT OF TEST on INDICATION PAPER ALARM DETECTED REMARKS L.____ DA FORM 1971-2-41 SEP 86 Chemical/Biological Sample Documentation For use of this form, see PM 3-3; the proponent agency is TRADOC. I INSTRUCTIONS I I Place the biological sample inside a refrigerator, ice chest, or insulated container; and keep it as cool as nannzkln n‘ n" ppablmu dl. an o: An LII IUD. Sample Identification Number: ha [JG I [I Chem/Bio Attack E] Chem/Bio Alarm Activated I I: Positive M256 Chemical Detection E] Positive Recon Team Findings '3 Soldiers Becoming Sick El Soldiers Dying D Other Location of Attack (UTM or place) Unit Identification I Terrain Description (check those that apply): _I:I_ Flat Q Hills I; Mountains D Desert DJungle DForest I CI Urban I: Grassy E] Sparse Trees/Shrubs C] Other I Weather (check those that apply): L_] Clear l_l Cloudy D Rain I_J Fog I_J Snow Ll Dust |_)Mist Wind at Collection Site (check only one): I [I] None/Calm E) Mild Breeze E) Windy C] Gusts I I Odor (check those that apply): I [3 None D Sweet D Fruity D Irritating '3 Pepper CI Flower I] Changing I: Other Symptoms (check those that apply): [I None CI Skin Swelling D Difficulty Breathing E] Blurred Vision I I I: Dizziness [:1 Skin Rash D Nausea CI Dry Mouth I E] Fever [3 Dark Skin Blotches El Unconscious El Headache D Bleeding Sores D Other Symptoms: I Time of Onset: Duration (of Symptoms): I L_____—_______________________J DA FORM 1971-6-R, OCT 92 Delivery Method (check those that apply): El Unknown D Mortar [:1 RPG/Grenade D Rocket I‘ A _ . _ _ a __ uenerator . gent at Time of Collection (check. only one)" I [:1 Liquid D Vapor E] Powder D Solid I: Smoke E] Mist I E] Dust (cloud) D Gel D Other Fl Vegetation Biomedical: , W . .uvuu Color of Sample | Size of Sample ' I Other . _————— \ f | Additional Remarks: l | i l I l i l I | I l l L______________| REVERSE, DA FORM 1971-6-R. OCT 92 NBC 1 Observer's Initial or Follow-Up Report For use of this form, see FM 3-3; the proponent agency is TRADOC. I From I T° I Precedence Security Classification [)FLASH El IMMEDIATE 7 77 Type of Report 7 afegory' Of Report I [I Nuclear [2 Initial B Chemical D Biological E] Follow-Up 1. Line items DELTA and HOTEL are mandatory for NBC 1 reports. 2. Line items ALFA, ECHO, GOLF, INDIA, KILO, LIMA, MIKE, SIERRA, YANKEE, and ZULU ALFA are optional for NBC 1 reports. 3. Line items BRAVO, CHARLiE, FOXTROT, PAPA ALFA ROMEO, ana' PAPA BRAVO ROMEO are reported if data is avaiiabie. Section l--Chemical or Biological Only -E_ I Strike Serial Number, if known (assigned by NBCE) I ALFA I I I I I I I I I Position of Observer Date and Time Attack Started (Zulu, local, or letter zone) Time Attack Ended, if known ECHO ocation of Mac I' TM or place) (state act-Ia! or FOXTROT Means of Déii‘v‘ 'y', if I WI GOLF Type of Agent and Height of Burst, if known HOTEL I Type and Number of Munitions or Aircraft (state I INDIA I I I I I I I I I which) Description of Terrain (bare, scrubby vegitation, KILO uunnrl A n han nr Ilh'lflh‘lllh‘ u u, ul I , UI unnnuvvu, Date and Time Contamination Detected SIERRA (Zulu, local, or letter zone) Representative Downwind Direction, 4 digits (state YANKEE degrees or mils), Wind Speed, 3 digits (state kmph or knots) Temperature (Centigradei' 2 digits, flow cover, 1 I ZULU ALFA I I I i i i i i i digit, Signigicant Weather Phenomena, 1 digit, Air Qq-ahilihl 1 Hinif UlaUIIILY, l UIQIL Remarks ZULU BRAVO DA FORM 1971-7-R, OCT 92 Section ll--Nuclear Only “- ALFA vumuer (assigned by u Date and Time Attack Started (Zuie, iocai, or ietter zone') NOVEMBER YANKEE mils) Effective \Mnd Speed (3 digits--kmph or knots) ZULU Donwwind Distance of Zone i (3 digits—km) Cloud Radius (2 igit «km, see Instruction 1) Remarks ZULU BRAVO REVERSE, DA FORM 1971-9-R. OCT NBC 2 Evaluated Data Report For use of this form, see FM 3-3; the proponent agency is TRADOC. I From I To | Precedence Security Classification | M M ED IATE Date-Time (Zulu, Local, or Letter Time Zone) Type of Re Category of Report if if E] Nuclear El Initial port l D Chemical [3 Biological E Follow-Up Instructions 1. Line items ALFA, DELTA, FOXTROT, HOTEL, and NOVEMBER are mandatory for NBC 2 reports. 2. Line items ECHO, GOLF, lNDlA, KILO, YANKEE, and ZULU ALFA are optional for NBC 2 reports. I Section l--Chemical or Biological Only I . e Serial N: u... Date and Time Attack Ended (Zuiu, iocai, or ietter zone) Means of Delivery, if known Type of Agent and Heught of Burst, if known HOTEL Number of Shells in Attack n-..,.5-:....:-_ A: T-.-,-:.. lka-A no; LI... Infin:056:n UU§Lllpl|Ull UI lulldlll \Udlb‘, §DIUUUY VUQILGLIU wooded, urban, or unknown) .— II Representative Downwind Direction, (4 digits, ‘YANKEE degrees or mils, state which), Wind Speed (3 digits, kmph or knots, state which) Temperature (Centigrade, 2 digits), Cloud Dover (1 digit), Significant Weather Phenomena (1 digit), Air Stability (1 digit) DA FORM 1971-8-R, OCT 92 Section ll--Nuclear Only Strike Serial Number (assigned by NBCE) ALFA Date and Time Attack Started | DELTA l l l I l l I l I (Zule, local, or letter zone) Location of Attack FOXTROT (UTM or place (actual or estimated, state which) " ', if known -0LF Type of Burst (air, surface, or unknown, state which) HOTEL AAA-on at n..| I U I Crater Diameter (meters), if known KILO IVIUdlIb U Estimated Yield (KT or MT) NOVEMBER ) Eva" D u Iy Remarks ZULU BRAVO REVERSE, DA FORM 1971-8-R. OCT NBC 3 Immediate Warning of Predicted Contamination and Hazard Areas For use of this form, see FM 3-3; the proponent agency is TRADOC. From Date-Time (Zulu, Local, or Letter Time Zone) Type of Report Category of Report D N-clear D Initial I [3 Chemical D Biological I D Follow-Up I 1. If effective wind speed is less than 8 kmph, line ZULU of the NBC nuclear report consists of only three digits for the radius of Zone I. ° ' inn “mm Al l3A, DELTA, FOXTROT, HOTEL, PAPA ALFA, and ZULU are mandatorv for NBC 3 re 1—- s—IHU Ilcllla nLI 3. Line items ECHO, NOVEMBER, PAPA BRAVO, and ZULU ALFA are optional for M355 reports. ' 4. Line item YANKEE is optional for chemical/biological NBC 3 reports; but, it is reported if available for nuclear NBC 3 reports. Section l--Chemical or Biological Only III-III- Date and Time Attack Started Coordinates of Predicted Hazard Area (if PAPA ALFA contours complete, or a complete circle, record the first grid coordinate as the first and the last coordinate) I I I I I I I I I Duration of Hazard (in days, hours, min., etc.) PAPA BRAVO Downwind Direction of Hazard and Wind YANKEE Speed (4 digits) Significant Weather Phenomena ZULU ALFA (see CDM for codes) I Remarks I ZULU BRAVO I I L—______J________L____—_—l DA FORM 1971-9-R, OCT 92 Section ll--Nuclear Only “ n-_.|,_ f‘-_!_l , “I.__ h-.._:__ n ____ “:__A: _ Al EA DIrlKe aerlal vumDer baUSIHQ bontamlnauon HLI'H I Date and Time Attack Started I DELTA I I I I I I I I I (Zulu, local, or letter zone) I Location of Ground Zero I FOXTROT I I I I I I I I I I Reference DTG of Estimated Contours When I OSCAR I I I I I I I I I Not at H + 1. Level of Radiatio An+unl Dad:a+:nn anual l|aulcuull Decay Rate n in c non-Lu “CDC . Y 1,000-cGyph Countour Line Coordinates (UTM) (coded red on overlay) 100-cGyph Countour Line Coordinates WHISKEY (UTM) (coded blue on overlay) 20—cGyph Countour Line Coordinates XRAY. (UTM) (coded black onoverlay) I Remarks I ZULU BRAVO I I [______l____J_______J REVERSE, DA FORM 1971-11-R. OCT 92 NBC 4 Radiation Dose Rate Measurements or Chemical/Biological Areas of Contamination For use of this form, see FM 3-3; the proponent agency is TRADOC. | From I To | Precedence Security Classification IM M ED lATE Date-Time (Zulu, Local, or Letter Time Zone) Type of Report Category of Report I] Nuclear I] initial I] Chemical [1 Biological E] Follow-Up 1. Line items QUEBEC, ROMEO, and SIERRA may be repeated as often as necessary. 2. Line items HOTEL, QUEBEC, ROMEO, and SIERRA are mandatory for NBC 4 reports. 3. Line items ALFA and KlLO are optional for NBC 4 reports. Section l--Chemical or Biological Only Description uer (ass C :Iln Curb-fl Mum innnnl In” MDPPI a In: ocular Ivuul Igllcu uy IVUUUI Type of Agent Description of Terrain (bare, scrubby KILO vegitation, wooded, urban, unknown) Location of Reading (UTM) QUEBEC (state whether test was air or liquid) Date and Time of Reading SIERRA l7nln Innnl nr lnH-nr 1nnal \L Iu U ITypeongent IHOTEL I I I I I I I Description of Terrain (bare, scrubby KILO vegitation, wooded, urban, unknown) I Location of Reading (UTM) I QUEBEC I I I I I I I I I (state whether test was air or liquid) Date and Time of Reading SIERRA I l7nln Innnl nr Infinr 1nnnl \hulu, luvull UI lusts" LUIIV’ Type of Agent HOTEL Description of Terrain (bare, scrubby KILO vegitation, wooded, urban, unknown) Location of Reading (UTM) QUEBEC (state whether test was air or liquid) I Date and Time of Reading I SIERRA I I I I I I I I I (Zulu, loca!, or letter zone) Remarks ZULU BRAVO DA FORM 1971-10-R, OCT 92 Section ll--Nuclear Only r (accin Al FA I \naolul . u.- - \ tion nod l'u/ ker‘r‘I Ivu uy I‘uuvr eribn Qgrinl lnmh ULIIRG UVI lul I'UIIIU CD III-III- Dose Rate (cGyph) (the words "Initial," "Peak," "Increasing," or "Decreasing" may be added) Date and Time of Reading SIERRA (Zulu, local, or letter zone) Location of Reading (UTM) QUEBEC and Time of Reading SIERRA (Zul , local, or letter zone) Remarks ZULU BRAVO NBC 5 Contamination Area Report For use of this form, see FM 3-3; the proponent agency is TRADOC. Precedence Security Classification | M M ED lAT E Type of Report Category of Report D Nuclear B Chemical D Biological 1. Line items HOTEL, TANGO, and XRAY are mandatory for chemical/biological NBC 5 reports. 2. Line item TANGO is reported if available for nuclear NBC 5 reports. 3. Line item XRAY is optional for nuclear NBC 5 reports. 4. Line items ALFA, DELTA, FOXTROT, ROMEO, SIERRA, UNIFORM, VICTOR, and, WHISKEY are optional for NBC 5 reports. 5. When a countour closes to form a completed ring, the first coordinate is repeated. 6. When requested, decay rates are to be transmitted according to line item ROMEO. Section l-—Chemical or Biological Only Strike Serial Number(s) Causing Contamination ALFA Date and Time Attack Started DELTA (Zulu, local, or letter zone) Type of Agent; Height of Burst HOTEL Date and Time Contamination Initially Detected SIERRA (Zulu, local, or letter zone) Date and Time of Latest Survey of Contamination TANGO in the Area (Zulu, local, or letter zone) Area of Tactical Significance of Toxic Contamination XRAY (UTMl (coded yellow on overlay) ZULU BRAVO . DA FORM 1971-11-R, OCT 92 Section ll--Nuclear Only “ Strike Serial Number, if known ALFA (assigned by NBCE) Date and Time attack st‘rted DEL (Zulu, local, or letter Zone) Location of Attack FOXTROT (UTM or place) (state actual or estimated) Means of Delivery, if known GOLF Tuna n‘F pure? ypw ul DUI; I. an, surface, or unknown) Fiash-to-Bang Time (seconds) I Crater Diameter (meters), if known I KILO I I I I I I I I I l Cloud Width at H + 5 Minutes | LIMA l l l l l I l l I (degrees or mils) Cloud Angle (top or bottom) or Cloud Height lfnn nr Inn” \ 99 H .1. 1n Iflinnfne \l L50 nm up VI UUllUIIl’ (II. I I I IV Ivllllu degrees, mils, meters, or feet) Downwind Direction of Radioactive Cloud PAPA BRAVO (state degrees or mils) ROMEO l Remarks l ZULU BRAVO l l | | l' l |__—_l___L—_______l REVERSE, DA FORM 1971-7-R, OCT 92 NBC 6 Detailed Information of Chemical or Biological Attack(s) For use of this form, see PM 3-3; the proponent agency is TRADOC. _ Precedence Security Classification | M M ED IAT E Date-Time (Zulu, Local, or Letter Time Zone) Type of Report Category of Report E] Initial '3 Chemical D Biological I] Follow-Up Instructions 1. Prepare this report to accompany chemical/biological samples sent for analysis or upon request. 2. Complete report in narrative form, giving as much detailed information as possible for each line item. “ Strike Serial Number (assigned by NBCC) ALFA Date and Time Attack Started DELTA (Zulu, local, or letter zone) Date and Time AttackEnded (Zulu, local, or letter zone) Area Attacked (location, UTM, or place) (state actual or estimated) Means of Delivery, if known GOLF - Type of Agent and Height of Burst, if known HOTEL I Number of Munitions or Aircraft INDIA Description of Terrain/Vegetation KILO Location (UTM) and Type of Sample(s) QUEBEC Date and Time Contamination Initially SIERRA Detected (Zulu, local, or letter zone) Date and Time of Latest Survey of Contamination TANGO (Zulu, local, or letter zone) Area of Measured Chemical Contamination (UTM) (coded yellow on overlay) Downwmd Direction (state degrees or mils ) and Wind Speed (kmph) Continued on reverse DA FORM 1971-12-R, OCT 92 IIIIIIII Remarks ZULU BRAVO REVERSE, DA FORM 1971-12-R, OCT 92 ...
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appc - CHEMICAL DATA SHEET '" PAGE NO- NO. OF...

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