Evaluation and Application of Methods for
Estimating Children' s Exposure to
Persistent Organic Pollutants in
Multiple Media
by
Jane C, Chuang, Christopher Lyu, Ying-Liang Chou, Patrick J. Callahan,
Marcia Nishioka. Kimberlea Andrews, Mary A. Pollard, Laura Brackney,
Charles Hines, Dave B. Davis, and Ronald Menton
Battelle
505 King Avenue
Columbus,Ohio 43201-2693
Volume II: Appendices A-C
Contract Number 68-D4-0023
Work Assignment 3-06
Project Officer
Nancy K, Wilson
Human Exposure and Atmospheric Sciences Division
National Exposure Research Laboratory
Research Triangle Park, North Carolina 27711
National Exposure Research Laboratory
Office of Research and Development
U.S. Environmental Protection Agency
Research Triangle Park, North Carolina 27711

-------
Appendix A. ANALYTICAL PROCEDURES FOR DUPLICATE DIET FOOD SAMPLES
SOLID FOOD SAMPLES
1.	Chop the entire food sample in the presence of dry ice. Transfer the chopped food sample into a
tared wide-mouth jar. Place the lid loosely on the jar and store the jar in a freezer for at least
overnight Weigh the jar with the food to determine entire sample weight
2.	Weigh a 50 gram aliquot of the food into a 200-250 mL glass centrifuge tube. Spike the sample
with the surrogate recovery standard. Add 100 mL methylene chloride to the sample.
3.	Homogenize the sample using a Brinkman homogenizer for 1 minute. Centrifuge the sample for
10 minutes at 80-90% power setting.
4.	Remove any aqueous phase which may be on top of the solid layer and reserve. Pour the organic
phase (bottom) through a bed of granular sodium sulfate into a Kuderna Danish (KD)
concentration set-up consisting of a silylated KD tube and a 500-rnL KD flask.
5.	Replace the aqueous phase in the centrifuge tube. Rinse the aqueous container with 3-10 ml
methylene chloride; add the rinses to the centrifuge bottle, Add another 70 mL of methylene
chloride to the bottle.
6.	Homogenize the sample using a Brinkman homogenizer for 1 minute. Centrifuge the sample for
10 minutes at 80-90% power setting.
7.	Remove any aqueous phase which may be on top of the solid layer and discard. Pour the organic
phase (bottom) through a bed of granular sodium sulfate into a KD set-up from step 4.
8.	Rinse the sodium sulfate with copious amounts of methylene chloride and add the rinses to the KD
set-up.
9.	Concentrate the extract to approximately 20 mL in a 65-7Q°C water bath. Dilute the sample to 24
mL with methylene chloride.
10.	Remove a 1 mL aliquot of the extract and place in a tared drying pan to determine the sample
residue weight. Allow the sample to dry in a fume hood for at least 1 hour. Weigh the pan
containing the residue and calculate the residue weight for the entire sample.
Residue Weight, g = (Weight of pan ^residue, g) - Weight of pan, g
Total Sample Residue, g = (Residue Weight, g) *(1 mL /24 mL)
11.	Place 2-6 mL aliquots of the extract into GPC autosampler tubes. Store the remainder of the
extract at approximately 4 °C.
12.	Calibrate the GPC (using the standard mix from Accustandard diluted 1:12 with methylene
chloride) using the following conditions and determine the dump and collect times:
Flow Rate: 5 mL/minute
Mobile Phase: Methylene chloride
13. Inject the samples and collect the necessary fraction in KD apparatus (using silylated glassware).
Typical times are as follows:
A-l

-------
Dump Time: 0 minutes to valley between vegetable oil and phthalate in the standard
(generally —25-28 minutes)
Collect time; from the end of the dump time to 60 minutes (generally 32-35 minutes)
14.	Concentrate the extract to approximately 5 rnL in a 65-70°C water bath.. Add approximately 1 mL
hexane and concentrate the sample to 1 mL, Split the sample into 2-500 fiL aliquots; one aliquot
will be used for OC, OP, PAH, and PCB analyses and one will be used for acidic compound
analysis.
15.	Add 25 \iL of methanol to the aliquot for acidic compounds. Methylate the aliquot using
diazomethane. This sample will be used in step 17.
16.	Florisil SPE for OC, OP, PAH and PCB analyses: Condition 1 gram flans il solid phase
extraction columns with 6 mL 15% ethyl ether in hexane, then 12 mL hexane; discard
conditioning solvents. Apply the sample to the column and collect the eluant. Rinse the sample
tube with 2-1 ml portions of hexane; add the rinses to the column. Allow the liquid to drain to just
above the column packing, Elute the column with 2-6 ml aliquots of 15% ethyl ether in hexane,
collecting the eluant in the same tube used above. Concentrate the sample to 0.5 mL in a 65-70cC
water bath. Spike with internal standard and mix the sample. Transfer the sample to two silylated
GC autosampler vial inserts. Store the samples at approximately -20°C until analyzed by GC-MS.
17.	Florisil SPE for acidic compound analyses: Condition 1 gram florisil solid phase extraction
columns with 6 mL 50% methylene chloride in hexane, then 12 mL hexane; discard conditioning
solvents. Apply the sample to the column and collect the eluant. Rinse the sample tube with 2-1
ml portions of hexane; add the rinses to the column. Allow the liquid to drain to just above the
column packing, Elute the column with. 2-6 ml aliquots of 50% methylene chloride in hexane,
collecting the eluant in the same tube used above. Concentrate the sample to 0,5 mL under a
stream of nitrogen. Spike with methylated internal standard solution and vortex mix the sample.
Transfer the sample to a silylated GC autosampler vial insert. Store one aliquot at approximately -
20°C until analyzed by GC-MSD.

-------
LIQUID FOOD SAMPLES
1.	Weigh the jar with the food to determine entire sample weight.
2.	Weigh a 25 gram aliquot of the food into a 200-250 mL glass centrifuge tube. Spike the sample
with the surrogate recovery standard. Add 100 mL methylene chloride to the sample.
3.	Homogenize the sample using a Brinkman homogenizer for 1 minute. Centrifuge the sample for
10 minutes at 80-90% power setting.
4.	Pour the sample into a separately funnel. Pour the organic phase (bottom) through a bed of
gianular sodium sulfate into a Kuderna Dauish (KD) concentration set-up consisting of a silylated
KD tube and a 250-rnL KD flask.
5.	Replace the sample in the centrifuge tube. Add 100 mL of methylene chloride to the bottle.
6.	Homogenize the sample using a Brinkman homogenizer for 1 minute. Centrifuge the sample for
10 minutes at 80-90% power setting.
7.	Pour die sample into a separatory funnel. Pour the organic phase (bottom) through a bed of
granular sodium sulfate into a KD set-up from step 4.
8.	Rinse the sodium sulfate with copious amounts of methylene chloride and add the rinses to the KD
set-up.
9.	Concentrate the extract to approximately 5 mL in a 65-70°C water bath. Dilute the sample to 6
mL with methylene chloride. Place the extract into a GPC autosampler tube.
10.	Calibrate the GPC (using the standard mix from Accustandard diluted 1:12 with methylene
chloride) using the following conditions and determine the dump and collect times;
Flow Rate: 5 mL/minute
Mobile Phase: Methylene chloride
11.	Inject the samples and collect the necessary fraction in KD apparatus (using silylated glassware).
Typical times are as follows:
Dump Time: 0 minutes to valley between vegetable oil and phthalate in the standard
(generally -25-28 minutes)
Collect time: from the end of the dump time to 60 minutes (generally 32-35 minutes)
12.	Concentrate the extract to approximately 5 mL in a 65-70°C water bath. Add approximately 1 mL
hexane and concentrate the sample to 1 mL. Split the sample into 2-500 |iL aliquots; one aliquot
will be used for OC, OP, PAH and PCB analyses and one will be use for acidic compound
analysis.
13.	Add 25 pL of methanol to the aliquot for acidic compounds. Methylate the aliquot using
diazomethane. This sample will be used in step 15.
14.	Florisil SPE for OP, OC, PAH and PCB analyses: Condition 1 gram florisil solid phase
extraction columns with 6 mL 15% ethyl ether in hexane, then 12 mL hexane; discard
conditioning solvents. Apply the sample to the column and collect the eluant. Rinse the sample
tube with 2-1 ml portions of hexane; add the rinses to the column. Allow the liquid to drain to just
above the column packing . Elute the column with 2-6 ml aliquots of 15% ethyl ether in hexane,

-------
collecting the eluant in the same tube used above. Concentrate the sample to 0,5 ml , in a 65-70°C
water bath. Spike with internal standard and vortex mix the sample. Transfer the sample to 2
silylated GC autosampler vial inserts. Store the samples at approximately -20°C until analyzed by
GC-MSD.
Florisil SPE for acidic compound analyses: Condition 1 gram florisil solid phase extraction
columns with 6 mL 50% methylene chloride in hexane, then 12 mL hexane; discard conditioning
solvents. Apply the sample to the column and collect the eluant. Rinse the sample tube with 2-1
ml portions of hexane; add the rinses to the column. Allow the liquid to drain to just above the
column packing . Elute the column with 2-6 ml aliquots of 50% methylene chloride in hexane,
collecting the eluant in the same tube used above. Concentrate the sample to 0.5 mL under a
stream of nitrogen. Spike with methylated internal standard solution and vortex mix the sample.
Transfer the sample to a silylated GC autosampler vial insert. Store one aliquot at approximately -
20°C until analyzed by GC-MSD.

-------
APPENDIX B. PHASE 1 FIELD STUDY;
Consent Form
Recruiting Materials
House/Building Characteristics Observation Survey
Pre-Monitoring Questionnaire
Post-Monitoring Questionnaire
Sketches of Daycare Centers
B-l

-------

-------
the environmental study
CONSENT FORM PAGE I OF 2
PARTICIPATION CONSENT FORM	LJ -1 I 1
The Environmental Study - Phase I
ABOUT THE RESEARCH STUDY
The Battelle Memorial Institute (Battelle), under a contract with the U.S. Environmental Protection Agency
(EPA), is conducting an environmental study in the research triangle area, North Carolina. The purpose
of this study is to develop methods for measuring possible pollutant exposure among children of pre-school
ages. With your help, our scientists may be able to develop ways to measure pollutant exposure among
young children, which may benefit the health of young children in the future. About nine day care centers
in the research triangle area will be selected to participate in this study.
DO I HAVE TO PARTICIPATE IN THE STUDY?
You do not have to participate in this study, participation is totally voluntary. You are free to withdraw
your consent and stop participation in the study at any time. You may also choose not to answer any
particular questions asked during the interview. Participation in this study does not mean that dangerous
levels of pollutants are present in your area. There is no risk to the children or staff in your day care
center. Except for the research staff directly involved in the study, no one will be able to identify you or
the day care center from the records or reports produced from this study. TKe identifying information will
be kept by Battelle and will be destroyed when the study is completed. No personal names or names of
the day care centers will appear in the reports, and no information from your day care center will be
available to regulatory agencies or anyone else requesting it. The study results will be available to you if
you request them. There is no direct benefit for you to participate in the study. But if you can participate,
you may help us develop ways to measure pollutant exposure of young children, which may benefit the
health of young children in the future.
Your participation is very important to the success of this study. Each day care center was selected through
a scientific procedure. It is very difficult to replace a day care center which has been selected for this
study. To thank you for your time and assistance, we will pay you (or the day care center) $50 after you
complete all study activities.
WHAT DO I NEED TO DO TO PARTICIPATE IN THE STUDY?
If you agree to participate, we will visit you at a scheduled time to do the following activities:
1.	Install an air monitor inside the day care center and an air monitor outside the day care center.
The purpose of installing the air monitor is to collect air samples in and around the day care center.
You will not have to watch these monitors. There is no risk or danger to the children or your
staff. They will be plugged into an electric outlet in the day care center. When the monitors are
running, they use very little electricity (it costs about 60 cents a day to run the monitors), and you
may hear some noise like a small fan. We will put the indoor air monitor in a playpen (we will
bring the playpen). The air monitors will be set up to run for about 48 hours.
2.	Draw a sketch of the floor plan of the day care center which will be used to mark the location of
the air monitors.
3.	Ask you some general questions about the day care center and the daily activities of the children.
AM WfSl IEPADA YK\!RB\DA YKCONl.EfA
February 28, 1997

-------
THE ENVIRONMENTAL STUDY
CONSENT FORM PACE 2 OF 2
4. Ask you to help us collect some samples of the foods that were provided to the children at the
center. We will give you containers and show you how to do it. We will also ask you to give us
a menu for the food items that were collected.
The interview with us will take about 30 minutes. Our research staff should complete all of the above
activities in about an hour. We will make an appointment with you for two days after our first visit Co
remove the air monitor. We will conduct the following activities during our second visit:
1.	Remove the air monitors.
2.	Collect some dust samples (using a vacuum) inside the day care center and take some soil samples
around the day care center.
3.	Pick up the food samples.
4.	Talk with you or a teacher of the classroom where we put the air monitor and ask some questions
about the children's daily activities during the 48-hour monitoring period.
Give you a certificate to thank you for your participation.
The interview with us will take about 20 minutes. Our research staff should complete all of the above
activities in about an hour. A $50 check will be mailed to you (or the day bare center) within two weeks
after you complete all study activities. It is possible that we may contact you again in about three months
to conduct a second data collection. Please feel free to ask questions. If our staff cannot answer your
questions, we will forward the questions to the investigator. If you have any questions about this study,
you may call Christopher Lyu, Study Manager, at (919) 544-3717. If you have any concerns about your
rights as a research participant, you may call Dr. Margaret Pennybacker, Chairperson of the
Battelle/CPHRE Institutional Review Board, at (919) 544-3717.
INFORMED CONSENT
I have read this 2-page consent form or it has been explained to me. I understand that my participation will
involve all of the activities described in this consent form. I have been given the chance to ask questions
and my questions have been answered. My signature below means that I have freely agreed to participate
in this study.
Please Print Your Name	Your Signature	Date
Study Staff's Signature	Date
N:I WPS I\EPADA YKWXBSDA YKCONl. EPA
February 28* 2997

-------
OBattelle
ruiuifg ieuintHCJgy to Work
Director Name
Day Care Name
Address
Battelle/CPHRE
100 Capitola Drive, Suite 301
Durham, North Carolina 27713
City, State, ZIP
Tel 919-544-3717
Fax 919-544-0830
DATE
Dear Director:
I am writing to ask for your help with a research study currently being conducted by the Battelle Memorial
Institute (Battelle), a not-for-profit research organization. The purpose of this study is to develop methods for
measuring potential pollutant exposure among children of pre-school ages. Very little research was done in the
past to investigate the potential sources of pollutants and how young children may be exposed to pollutants.
With your help, our scientists may be able to develop effective methods for measuring pollutant exposure among
young children, which may benefit the health of young children in die future. This study is funded by the U.
S. Environmental Protection Agency.
Participation in this study does not mean that there are pollutants in your area. There is no experimental
procedure involved in the study and there is no risk to the children or staff in your day care center. The
information we collect will be used only for the purpose of this study. The researchers conducting this study
are committed to protecting the privacy of all participants. Except for the research staff directly involved in
the study, no one will be able to identify you or the day care center from the records or reports produced from
this study. The identifier information will be kept by Battelle and will be destroyed when the study is
completed. No personal names or names of the day care centers will be identified in the reports, and no
individual data will be available to regulatory agencies or anyone else requesting information. The study results
will be presented in an aggregate format only and will be available to you if you request it.
Participation is voluntary. Participation will involve two brief interviews with our research staff and your
permission to allow us to collect air, food, dust, and soil samples from your day care center. A detailed
description of the study activities is provided in the attached Participation Summary. There will be no costs to
you for participation in this study. You are free to withdraw your consent and stop participation in the study
at any time. You may choose not to answer any particular questions asked during the interview.
To compensate for your time and assistance, we will pay you $50 after the completion of all study activities.
Our research staff will call you over the next few days to answer any questions you may have. We look forward
to talking with you and hope that you will be interested in participating in this important study.
Sincerely,
Christopher W. Lyu, MPA
Study Manager
N:\VW5 nEPAQAYK\tmL£TTEfiDAY

-------
Participation Summary
If you agree to participate, we will schedule an appointment with you at your convenience to conduct the
following activities;
1.	We will install an air monitoring module inside the day care center and an air monitoring
module outside the day care center. The purpose of installing the air monitoring modules
is to collect air samples in and around the day care center. They do not need to be
attended. The noise that the monitors put out is like a small fan. There is no risk or
danger to the children or your staff. They will be plugged into an electric outlet in the day
care center. When the monitors are running, they use very little electricity (it costs about
60 cents a day to run the monitors). To secure the indoor air monitor, we will put the
indoor air monitor in a playpen (we will bring the playpen).
2.	Our staff will draw a sketch of the floor plan of the day care center which will be used to
mark the location of the air monitors.
3.	You will be asked to answer questions about some general information of the day care
center and the daily activities of the children.
4.	We will ask you to help us collect some samples of the foods that were provided to the
children. We will provide containers and show you how to collect the food samples. We
will also ask you to give us a menu for the food items that were collected.
We will only need about 30 minutes of your time to complete the interview with us. Our research staff
should complete all of the above activities in about an hour. The air monitors will be set up to run for
about 48 hours and we will schedule another appointment with you two days after our first visit to remove
the air monitors. We will conduct the following activities during our second visit:
1. The air monitors will be removed.
2.	We will collect some dust samples (using a vacuum) inside the day care center and take
some soil samples around the day care center.
3.	We will pick up the food samples.
4.	You will be asked to answer questions about the children's daily activities during the 48-
hour air monitoring period.
5.	We will give you a certificate to thank you for your participation.
It will only take about 20 minutes of your time to complete the interview with us. Our research staff will
complete all of the above activities in about an hour. A $50 check will be mailed to you within two weeks
after the completion of all study activities.

-------
Suggested Scripts for Contacting the Day Care Director
PURPOSES
OF THE CALL: To ask the day care center director if he/she is interested in participating in the study and
to answer their questions about the study.
«" The letters were mailed on January 28, 1997 to all Head Start centers and regular day care centers
located in Durham and Chapel Hill. For now we are only calling the Durham/Chapel Hill area (116
on the list) and all of the Head Start centers (5 on the list). Do not call the Raleigh area.
We will begin calling on Tuesday, February 4,1997. Please use the following suggested scripts in
a spontaneous way (your way) to communicate the key information with the respondents.
Script 1. Initial Contact
•a* Hello, Hi, Good Morning/Afternoon, etc. [GREETINGS]
w My name is fNAMEV May I speak with (NAME OF DIRECTOR or the director of the day care
center) please?
IF ASKED WHY CALLING THE DIRECTOR:
» I am calling for Battelle Memorial Institute to follow-up on a letter we sent to (NAME OF
DIRECTOR/your director) a few days ago. It is about a research study currently being conducted by
Battelle Memorial Institute.
Script 2. Talking with the Day Care Director
® (Hello, Hi, Good Morning/Afternoon, etc.) Mr./Ms./Mrs. (RESPONDENT'S NAME) [GREETINGS]
*"¦ My name is (NAME). I am calling for Battelle Memorial Institute to follow-up on a letter we sent you
a few days ago. It is about a research study currently being conducted by Battelle. Have you received
the letter from us?
~ IF YES (did receive the letter):
Do you have any questions about the study?
[IF YES, TRY TO ANSWER THE QUESTIONS; REFER TO THE Q&A FOR ANSWERS]
»¦ IWP? I \FPADA mFORUVSCXirr. M Y	Page I	January 29, 1997

-------
Suggested Scripts for Contacting the Day Care Director
«* Would you be interested in participating in the study?
IF YES:1*" Thank you for your interest. I will call you again within two weeks to confirm your
participation. The principal investigator will make the final decision on the selection of
eligible centers to participate in the study.
[RECORD THE RESULTS ON THE TRACKING LOG]
IF NO:<«* Do you have any particular concerns or questions about the study? (Would you tell me
why you are not interested in participating in the study?)
[TRY TO ANSWER THE QUESTIONS AND CONCERNS]
w Is there anything we can do to change your mind to participate in the study?
[MENTION THE CONFIDENTIALITY, THEIR CONTRIBUTION/IMPORTANCE TO THE
STUDY, $50 COMPENSATION, ETC.]
w Thank you for your time. Goodbye,
[RECORD CONCERNS AND REASONS OF REFUSAL]
~ IF NO (did not receive the letter):
ra- Do you have a few minutes that I can explain the purpose of the study to you?
IF YES:*** The study is being conducted by Battelle Memorial Institute. Battelle is a not-for-profit
research organization. The purpose of this study is to develop methods for measuring
potential pollutant exposure among children of pre-school ages. Very little research was
done in the past to investigate the potential sources of pollutants and how young children
may be exposed to pollutants. With your help, our scientists may be able to develop
effective methods for measuring pollutant exposure among young children, which may
benefit the health of young children in the future,
•®" Participation in this study does not mean that there are pollutants in your area. There is no
experimental procedure involved in the study and there is no risk to the children or staff
in your day care center. The information we collect will be used only for the purpose of
this study. The researchers conducting this study are committed to protecting the privacy
of all participants. Except for the research staff directiy involved in the study, no one will
be able to identify you or the day care center from the records or reports produced from
this study.
N:\WPSl\EPAl>AmFOXMSUXXPT.DAY	Page 2	lawuy 29. 1997

-------

Suggested Scripts for Contacting the Day Care Director

-------
Answers to Common Participant Questions
nmnanms
Q: What pollutants are you looking for?
A: The researchers are interested in developing methods to measure potential pollutants in the air we
breathe, the soil and dust around our houses, and the food we eat. The pollutants may come from
many different sources, such as car exhaust, cigarette smoking, etc.
Q: How will you select the centers?
A: The centers will be selected according to the following criteria:
1)	children's age group: Only centers serving pre-sehool ages children will be selected.
2)	type of center: About half of the centers (4 or 5) will be Head Start centers and the other half will
e regular centers. The researchers would like to evaluate Field methods that can be applied to both
types of day care centers,
3)	locations of centers: About half will be centers located near heavy traffic areas ami the other half
will be centers located in the light traffic areas.
Q: What would you do if your study found something bad in my center?
A: Currently there are no EPA exposure standards available for the potential pollutants to be determined
in this study. The purpose of the study is to develop methods for monitoring these pollutants. We are
not in the position to define what pollutants levels are bad for you. A lot of studies need to be done
to answer this question.
Q: After the completion of study activities, do you give the $50 to me (day care director) or to the center?
(Is the money for me to keep?)
A: We will give you the money. It will be a check addressed to you in your name. The $50 is just a
token from us to say "Thank You" for your time and assistance. You may use the money any way you
like.
Q: What is this study about?
A: The purpose of this study is to develop methods for measuring potential pollutant exposure among
children of pre-school ages. Very little research was done in the past to investigate the potential
sources of pollutants and how young children may be exposed to pollutants. With your help, our
scientists may be able to develop effective methods for measuring pollutant exposure among young
children, which may benefit the health of young children in the future.
WiWPSlWADAmillBSQ&A.EPA
Page 1
Jamaty 24, 1997
-------
Answers to Common Participant Questions
Q; If my center is selected, does that mean we are exposed to some kind of dangerous pollutants?
A: No. Participation in this study does not mean that there are dangerous or hazardous pollutants in your
area. You should not be concerned about your safety if your center is selected to participate in the
study. The researchers are interested in developing methods to measure the potential pollutants in our
environment. The centers will be selected according to the following criteria:
1)	children's age group: Only centers serving pre-school ages children will be selected.
2)	type of center: About half of the centers (4 or 5) will be Head Start centers and the other half will
be regular centers. The researchers would like to evaluate field methods that can be applied to
both types of day care centers.
3)	locations of centers: About half will be centers located near heavy traffic areas and the other half
will be centers located in the light traffic areas.
Q: Are we going to be in some kind of experiments if we participate?
A: No. There is no experimental procedure involved in the study and there is no risk to the children or
staff in your day care center.
Q: Who will see the information I give you? How will the information be used? Will my name or the
name of the day care be put in a report?
A: The information we collect will be used only for the purpose of this study. The researchers conducting
this study are committed to protecting the privacy of all participants. Except for the research staff
directly involved in the study, no one will be able to identify you or the day care center from the
records or reports produced from this study. The identifier information will be kept by Battelle and
will be destroyed when the study is completed. No personal names or names of the day care centers
will be identified in the reports, and no individual data will be available to regulatory agencies or
anyone else requesting information. The study results will be presented in an aggregate format only
and will be available to you if you request it.
Q: How do I know that the information I give you will be kept confidential?
A: Our research staff working on the study are professionals and everyone has signed an assurance of
confidentiality. In addition, there is an Institutional Review Board in our company that oversees the
issues of protecting research participants. If you have any concerns about your rights as a research
participant, you may call Dr. Margaret Pennybacker, Chairperson of the Battelle/CPHRE Institutional
Review Board, at (919) 544-3717.
N:\WPSP£PADAmimQAA,BPA
Page 2
Jmmiy 24, 1997
-------
Answers to Common Participant Questions

Q: Can I change my mind later about participating in die study?
A: Yes. You are free to withdraw your consent and stop participation in the study at any time. In
addition, you may choose not to answer any particular questions asked during the interview. However,
we will pay you $50 only if you complete all of the study activities with us.
Q: Am I required to do this?
A: No. Participation is voluntary.
Q: Do I have to pay you for participation?
A: No. There will be no costs to you for participation in this study. To compensate for your time and
assistance, we will pay you $50 after the completion of all study activities.
Q: How do I benefit from participating in this study?
A: There is no direct benefit for you to participate in the study. But if you can participate, the information
you provide may help us develop methods for measuring the potential pollutant exposure of young
children, which may benefit the health of young children in the future. To compensate for your time
and assistance, we will pay you $50 after the completion of all study activities.
Q: Will I receive a copy of the study results?
A: If you are interested in receiving a copy of the study results, we will send you one when the study is
completed. It may take up to two years for the researchers to complete all the analysis work and
prepare the final report.
Q: Who are the researchers?
A: The principal investigator is Jane Chuang. She is a senior research scientist with Battelle for over 18
years. (The EPA project officer is Dr. Nancy Wilson. Her office is located in the Research Triangle
Park.)
Q: Who do you work for? Where are you getting the money for this study?
A: We work for a not-for-profit research company called Battelle Memorial Institute (Battelle). This
project is funded by the U. S. Environmental Protection Agency (EPA).
N; 1WPS J \£PADA YK\JR8\QAA£PA
Page 3
January 24, 1997
-------
Answers to Common Participant Questions

Q: What exactly will I have to do if I participate? (Day Care Center Protocol)
A: If you agree to participate, we will schedule an appointment with you at your convenience to conduct
the following activities:
1.	We will install an air monitoring module inside the day care center and an air monitoring module
outside the day care center. The purpose of installing the air monitoring modules is to collect air
samples in and around the day care center. They do not need to be attended. The noise that the
monitors put out is like a small fan. There is no risk or danger to the children or your staff. They
will be plugged into an electric outlet in die day care center. When the monitors are running, they
use very little electricity (it costs about 60 cents a day to ran the monitors). To secure the indoor
air monitor, we will put the indoor air monitor in a playpen (we will bring the playpen).
2.	Our staff will draw a sketch of the floor plan of the day care center which will be used to mark the
location of the air monitors.
3.	You will be asked to answer questions about some general information of the day care center and
the daily activities of the children.
4.	We will ask you to help us collect the same portion of foods that are provided to each child at your
center. We will provide containers and show you how to collect the food samples. We will also
ask you to give us a menu for the food items that were collected.
We will only need about 30 minutes of your time to complete the interview with us. Our research staff
should complete all of the above activities in about an hour. The air monitors will be set up to run for
about 48 hours and we will schedule another appointment with you two days after our first visit to remove
the air monitors. We will conduct the following activities during our second visit:
1.	The air monitors will be removed.
2.	We will collect some dust samples (using a vacuum) inside the day care center and take some soil
samples around the day care center.
3.	We will pick up the food samples.
4.	You will be asked to answer questions about the children's daily activities during the 48-hour air
monitoring period.
5.	We will give you a certificate to thank you for your participation.
It will only take about 20 minutes of your time to complete the interview with us. Our research staff will
complete all of the above activities in about an hour. A $50 check will be mailed to you within two weeks
after the completion of all study activities.
AM WK! IEPADA miW\Q&A. LP A
Page 4
Jmmry 24, 1997
-------
The Environmental Study
House/Building Characteristics Observation Survey
(CHILD DAY CARE CENTER)
1997
PARTICIPANT ID#: LI-LLJ
BBS
-------
RECORD:
0 1
INTERVIEW INFORMATION
SUBRECORD:
0 0
PARTICIPANT ID #: LULL
VERSION;

INTERVIEWER
ID#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
1 1 i
1 1 1! Ml 1!


COMPLETE ..... t
INCOMPLETE	2

MM DD YY


02
1 1 !
1 MM III 1
II 1*11 1 AX/f f

COMPLETE 	1
INCOMPLETE	2

MM DD YY


03
1 1 1
II 1! Ml M


COMPLETE ..... L
INCOMPLETE	2
1 '
MM DD YY


04
1 1 1
1 Mi 1 II II


COMPLETE 	1
INCOMPLETE .... 2

MM DD YY


REASONS FOR NONCOMPLETION:
01
02
03
04
N;Wm\ErADAYXSFOm^OBS-QLEPA
Page 1
02/W9?
-------
SECTION A	HOUSE/BUILDING FLOOR PLAN
SKETCH THE INTERIOR OF THE HOUSE/BUILDING AND MARK AREAS SAMPLED WITH AN "X." USE A COMPASS
TO DETERMINE THE DIRECTIONS OF THE HOUSE AND MARK THE DIRECTIONS ON THIS SKETCH.
mmi>£PM)AriClfOM/S\OBS-QJ,£fA
Page 2
02/18J97
-------
SECTIONS
HOUSE/BUILDING EXTERIOR
Bl. TYPE OF BUILDING STRUCTURE:	ONE-STORY HOUSE 			01
ONE-STORY DUPLEX 				02
TWO-STORY HOUSE			03
TWO-STORY DUPLEX			.04
TRAILER/MOBILE HOME			05
APARTMENT 		.......			06
OTHER (SPECIFY) 					 07
REFUSED 				97
DK						.98
[SPECIFY OTHER:] 	LJ
B2. BUILDING MATERIALS - ROOF:	METAL			1
WOOD SHINGLES OR PLYWOOD	2
ASPHALT SHINGLES				 . . 3
OTHER (SPECIFY)	4
[SPECIFY:] 	,		
B3. BUILDING MATERIALS - SIDING:	VINYL SIDING ONLY 					1
BRICK ONLY 					2
BEADED SIDING			.... 3
BLOCK					4
WOOD 			 				5
BRICK AND VINYL/BEADED SIDING 			6
BLOCK AND VINYL/BEADED SIDING	7
OTHER (SPECIFY) 						8
[SPECIFY:] 		
B4. BUILDING FOUNDATION:	BLOCKS			1
SLAB			2
CRAWL SPACE . . 				3
BASEMENT				 . 4
OTHER (SPECIFY)					5
[SPECIFY:] 		
B5. IS THERE A FRONT PORCH/	YES 								1
BALCONY?	NO			2
B6. IS THERE A DECK OR PORCH/	YES					1
BALCONY IN THE BACK OF THE	NO 						2
HOUSEBUILDING?
N:\WSl\EfABAtK\FOHMSiOaS-ai.tfA
Pige 3
02/13/97
-------
SECTION B
HOUSE/BUILDING EXTERIOR
B7. IS THERE A CONCRETE (OR PAVED)
DRIVEWAY?
YES
NO .
[IF NO, SPECIFY:]
B8. IS THERE A CONCRETE (OR PAVED)
WALKWAY FROM THE DRIVEWAY TO
THE HOUSE/BUILDING?
YES . .
NO . . .
. 1
. 2
[IF NO, SPECIFY;]
B9. CONDITION OF EXTERIOR STRUCTURE;
a.	WELL MAINTAINED					1
b.	PEELING PAINT 			1
C, SIDING IN DISREPAIR 		1
d.	PARTS OF SIDING OR ROOFING LYING IN YARD . .	1
e.	BROKEN WINDOWS			1
f.	BROKEN DOORS 				1
g.	GENERALLY DETERIORATED		1
m
2
2
2
2
2
2
2
BIO. DESCRIBE THE AREA OUTSIDE IN
FRONT OF THE HOUSE/BUILDING
(> =MORE THAN):
YARD > 50% COVERED WITH LAWN, TREES, ETC.	1
YARD > 50% BARE DIRT/MUD			2
YARD > 50% PAVED 		3
OTHER (SPECIFY)			4
™	~
Bll.
DESCRIBE THE AREA OUTSIDE IN THE
BACK OF THE HOUSE/BUILDING
(> =MORE THAN):
B12.
DESCRIBE THE AREA OUTSIDE ON
THE LEFT SIDE (YOUR LEFT WHEN
YOU FACE THE BUILDING) OF THE
HOUSE/BUILDING
(> =MORE THAN):
YARD > 50% COVERED WITH LAWN, TREES, ETC.	1
YARD > 50% BARE DIRT/MUD 			2
YARD > 50% PAVED 						3
OTHER (SPECIFY)					4
[SPECIFY:].
YARD > 50% COVERED WITH LAWN, TREES, ETC.
YARD > 50% BARE DIRT/MUD			
YARD > 50% PAVED 					
OTHER (SPECIFY) 		
1
2
HMKl \ETADA mfOgMmOBi-aiEPA
Page 4
01/18197
-------
SECTION B
HOUSEBUILDING EXTERIOR
[SPECIFY:].
n
B13. DESCRIBE THE AREA OUTSIDE ON
THE RIGHT SIDE (YOUR RIGHT WHEN
YOU FACE THE BUILDING) OF THE
HOUSE/BUILDING
(> =MORE THAN):
YARD > 50% COVERED WITH LAWN, TREES, ETC.	I
YARD > 50% BARE DIRT/MUD				2
YARD > 50% PAVED 				3
OTHER (SPECIFY)		 				4
[SPECIFY:].
BI4. IS THERE ANY ODOR OUTSIDE? IF YES, DESCRIBE IT.
a.	FRONT OF HOUSE/BUILDING	
b.	BACK OF HOUSE/BUILDING ......
c.	LEFT SIDE OF HOUSE/BUILDING . .
d.	RIGHT SIDE OF HOUSE/BUILDING .
YES
1
1
1
1
m
2
2
2
2
[DESCRIPTION:].
D
B15. IS THERE STANDING WATER OR ANY
DISCHARGE INTO THE YARD OR
AROUND THE HOUSE/BUILDING?
(SUCH AS DISCOLORED WATER/ MUD,
ETC. FROM INDUSTRIAL, SEWAGE,
OR HOUSEHOLD WASTE)
YES
NO .
1
2
[IF YES, CAN YOU SEE WHERE IT'S COMING FROM:]
B16. IS THERE EVIDENCE THAT RUBBISH	YES	I
BURNING WAS DONE ON THE	NO	2
PROPERTY?
[IF YES, DESCRIBE:] 	,	:			
B17. IS THERE EVIDENCE THAT GARBAGE	YES 			I
WAS DUMPED IN THE YARD?	NO			2
[IF YES, DESCRIBE;] 			—
MWP]liEPAMmJ>amS\OBS-Ql.EI'A
Page 5	os/ii/37
-------
SECTION B
HOUSE/BUILDING EXTERIOR
B18, IS GARBAGE STORED IN CONTAINERS	YES		 				1
IN THE YARD OR AROUND THE	NO							2
HOUSE/BUILDING??
[IF NO, DESCRIBE WHAT/HOW:] 		
B19. ARE THERE ANIMALS LIVING IN THE	YES						 I
YARD OR AROUND THE	NO ......... 				2
HOUSE/BUILDING??
PF YES, DESCRIBE;] 	—
B2G. DO YOU SEE ANIMAL FOOD AND/OR	YES							1
DROPPINGS/FECES IN THE YARD OR	NO							2
AROUND THE HOUSE/BUILDING?
[IF YES, DESCRIBE:] 	0
N.-,WK!\£PAOA YKSFOHMSSCB&Ql.EfA
Page 6
aajia/a?
-------
SECTION C
HOUSEBUILDING LOCATION & SURROUNDING AREA
CI. DISTANCE TO STREET:	FRONT OF HOUSEBUILDING: 1111 ft
BACK OF HOUSE/BUILDING;	I I I 1 ft
RIGHT SIDE OF HOUSE/BUILDING: till ft
C2. TRAFFIC CONDITIONS AT TIME OF	LIGHT (LESS THAN t car/5 MIN) 	1
OBSERVATION:	MODERATE CM CARS/5 MM)					2
HEAVY (5 CAES OR MORE/5 MIN)		 3
[SPECIFY g OF CARS/5 MINUTES:]	Li	I
[TIME OF OBSERVATION:]	I	I	I : 1	I	I AM/PM
C3. FRONT ENTRANCE OF BUILDING:	AT STREET LEVEL			1
BELOW STREET LEVEL				 2
ABOVE STREET LEVEL	3
C4. ARE THERE STAIRS AT THE FRONT	YES				 		1
ENTRANCE?	NO							.2
C5. SURROUNDING AREA:	RESIDENTIAL					I
RECREATIONAL					2
COMMERCIAL			3
INDUSTRIAL		 4
WOODED	5
MIXED (SPECIFY)			6
[SPECIFY:]
MM writ IEPADA YKSFOHMS.OBS-Qt.Ef-A
Page 7

-------
SECTION C
HOUSEBUILDING LOCATION A SURROUNDING AREA
€6. HOUSE/BUILDING SURROUNDING AREA;
YES	HQ
a.	CONSTRUCTION SITE				1	2
b.	DEMOLITION SITE			1	2
c.	VACANT/LITTER/DUMP SITE		1	2
d.	UNINHABITED BUILDINGS			1	2
e.	ADJACENT HOMES IN POOR CONDITION	1	2
I. PUBLIC HOUSING PROJECT ...........	1	2
g.	FARM OR AGRICULTURAL AREA		I	2
h.	LAGOON OR DRAINAGE DITCH 		1	2
i.	POWER LINES 			I	2
j. MANUFACTURING FACILITIES		1	2
k. INDUSTRIAL STORAGE FACILITIES		1	2
1. IRRIGATION DITCHES/CANALS 			1	2
m. GARBAGE DUMPS 		1	2
n. STANDING WATER			1	2
0. RAILROAD/RAILROAD STATION		1	2
p. SHOPPING CENTER(S) 				1	2
q. GAS STATION 			1	2
r. GREEN HOUSE/NURSERY/GARDEN		1	2
fmWPSIWADAyXWORMShOBS.QLEPA
Page 8
02/18/97
-------
SECTION C	HOUSE/BUILDING LOCATION & SURROUNDING AREA
	LOCATION & SURROUNDINGS OF THE HOUSE	
SKETCH THE LOCATION AND SURROUNDINGS OF THE HOUSEBUILDING. MEASURE THE APPROXIMATE
DIMENSIONS OF THE HOUSE/BUILDING AND THE SIZE OF THE YARD (FRONT/BACK/SIDES),
M:SWPiHEPADAmFOItMSIOBS-a!.SfA
Page 9
OU1&27
-------
The Environmental Study
Fre-Monitoring Questionnaire
(CHILD DAY CARE CENTER)
1997
PARTICIPANT ID#: I l-l M
-------
The Environmental Study	Pre-Monitoring Questionnaire/Par Care Center
INTERVIEW INFORMATION
PARTICIPANT ID#: I I.I II
RECORD: I 0 I 1 I	SUBRECORD: 1 0 1 0 I	VERSION; I 0 » 1

INTERVIEWER
m#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY SEASON)
01
1 1 1
1 1 II Ml M


COMPLETE 	1
INCOMPLETE	2

MM DD YY


02
1 1 1
1 Ml 1 II II

1 1 1 - 1 1 I iU,W
COMPLETE 	1
INCOMPLETE	2

MM DD YY


03
1 1 1
1 Ml Ml II


COMPLETE 	1
INCOMPLETE	2

MM DD YY


04
1 1 1
1 Ml III II
I I 1 • 1 1 1 i.\M / PVf
1 1 I.I 1 M*,,™
COMPLETE 		I
INCOMPLETE	2

MM DD YY


REASONS FOR NONCOMPLETION:
01
02
03
04
RESPONDENT'S COOPERATION WAS;	VERY GOOD	. .			1
GOOD 				 . . 	2
FAIR 		 		3
POOR			4
THE OVERALL QUALITY OF THIS	HIGH QUALITY . 		 1
INTERVIEW WAS:	GENERALLY RELIABLE 		 2
QUESTIONABLE	 (SPECIFY BELOW). . . 3
UNSATISFACTORY	 (SPECIFY BELOW). . .4
REASON(S) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
ni^EPADArmFomsfKE-Qi.Ei'A
PAGE 1
02/ta& 7
-------
The Environmental Study
Pre-Manitortog Questionnaire/Day Care Center
SECTION A

CHARACTERISTICS OF THE DAY CARE CENTER
n this interview I would like to ask you some general questions about the day care center.
Al.
How many years has the day care center been
operated at this location?
1 1 1
YEARS
(DK = 98)
A2.
What is the maximum number of children that your
center can enroll?
1 1 II
# of Children
A3.
What is the total number of children currently
enrolled in your center?
1 1 II
# of Children
A4,
How many classrooms do you have?
ASK AS THEN A6 FOR EACH AGE GROUP.
1 1 1
# of Classrooms

A5.
A6.

Would you please tell me the age group of the
children in each classroom?
How many classrooms do you have for the (AGE GROUP)?
Class-
room
Children's Age Group
Number of Classroom
01

1 1 I
02

III
03

1 1 I
04

1 1 1
05

I 1 !
06

1 I 1
07

1 1 1
08

1 i 1
09

1 1 i
10

1 1 1
VPS I \£PADA Y10fCRMS
-------
The Environmental Study
Pre-Monitoring Quertionnalre/Day Care Center
A7, What is the tuition and registration fee for enrolling IF THEY HAVE A CURRENT RATE SCHEDULE, ASK
a child in your center?	FOR A COPY AND YOU MAY COMPLETE IBIS
QUESTION LATER.
RECORD TUITION/FEE FOR EACH CATEGORY.

Category
Tuition
Fee
01


-
02



03



04



05



06



07



A7a. Do you have any children in the center who are also	YES 			1
enrolled in the Head Start program?	NO 				2
A8. How old is this (building/house)?	III!
YEAKS
(DK = 998)
A9. Does the day care center own or rent this	Own 	I
(building/house)?	Rent		 						2
Other 					3
DK							8
[SPECIFY OTHER:!
¦S" NOW ASK FOR A FLOOR PLAN OF THE BUILDING (IF AVAILABLE).
"S* IF NO FLOOR PLAN, ASK THE RESPONDENT TO HELP YOU DRAW A SKETCH.
RECORD THE NAME OF EACH ROOM ON THE FLOOR PLAN/SKETCH.
H:\WFSt mfOmSWRE'Ql.&A
PAGE 3
02/1 m 7
-------
The Environmental Study
Fir-Monitoring Questionnaire/Day Care Center
USE THE FLOOR PLAN/SKETCH AS A REFERENCE WHEN YOU ASK A10. THEN ASK A11-A13 FOR EACH ROOM.
A10.	All.	A12.	A13.
Would you tell me which rooms have carpet or
area rugs? [SHOW FLOOR PLAN]
How old is the
carpet/area rugs
in the (ROOM)?
In the past 3 months, was the
carpet/area rags in the
(ROOM) steam- or dry-
cleaned?
In the past week, was the
carpet/area nigs in the
(ROOM) vacuumed?
ROOM
Yes No
DK=98
Yes No DK
Yes No DK
m
1 2
I I.... (years
1 1 1 Month*
1 2 8
12 8
m
1 2
1 ,1 ...J Years
1 1.. ,1 Months
1 2 8
1 2 8
3.


1 2

1 2 8
1 2 8


t.... 1 i Years
1—1—1 Months
4*

1 2
I 1 1
1 2 8
1 2 8
1 1

5.

1 2

1 2 8
1 2 8
1 1
1 1 1 Mnnrhs
6.

1 2

1 2 8
1 2 8
1 1
1 1	1 Mrmrfts
7.

1 2

1 2 8
1 2 8
1 1
1	 1—i Years
1	1—1 Months
8.

1 2
1 1 1 v.,«
I I 1
1 2 8
1 2 8
I |
9"

1 2
1	1	...! Years
I , 1 1 MnnttT!
1 2 8
1 2 8
1 1
,0.

1 2

1 2 8
1 2 8
1 1
1—1, .1 Months
11.

1 2
1 1 i
1 2 8
12 8

1—1	i Years
L	1—1 Months
12.


1 2
i 1 1
1 2 8
1 2 8


I 1 1 Years
1	L	1 Months


13.


1 2

1 2 8
12 8


1	1			J Months
14.


1 2
I 1 1 V.„-
1 2 8
1 2 8


1 1 1 Mnmh!
m-i wrsmrmii mFOHMSFse-QUBrA
PAGE 4
02J1W7
-------
The Environmental Study
Prt-Monitorliig Questionnaire/Day Care Center
The following questions are about the heating device you use to provide heat for the center.
[ASK A14 FOR ALL HEATING DEVICE® USED, THEN ASK A15-A17 FOR EACH HEATING DEVICE.]
A14.	A15.	A16.	A17.
What kind of heating device do you use? Please
On the average, about
When you used (HEAT)
When was (HEAT) last
include anything you use on an occasional basis.
how many days per
in the past winter, on the
used?





month did you use
average about how many

CIRCLE ALL THAT APPLY


(HEAT) in the past
hours per day did you
(DK = 98 98 98)





winter?
use it?
-
HEAT
Yes
No
## Days/Month
## Hrs./Day
MM/DD/YY
a. CENTRAL ELECTRIC
1
2






b. CENTRAL GAS
1
2



1


c. KEROSENE SPACE HEATER
1
2






d. ELECTRIC SPACE HEATER
1
2






e. FIREPLACE
1
2






f. WOOD STOVE
1
2






%. OTHER (SPECIFY)
1
2









h. OTHER (SPECIFY)
1
2









i. OTHER (SPECIFY)
1
2









j. OTHER (specify)
1
2









N: i wrsi iepada mfosMswm-gi.EPA
PAGES
Q2/1&37
-------
The Environmental Study
Fre-Monitorteg Questtonnalrt/Day Care Center
A18. Is the center located within a quarter mile of any	YES					1
major freeway or industrial or incineration plants that	NO	.			2
produce lots of smoke or a strange smell?	DK			8
{IF YES. SPECIFY:] 		L_L_
A19, What type of sewage system is used in the center?	MUNICIPAL	.. I ....... . 1
SEPTIC TANK		 2
CESSPOOL . 				3
OTHER 		4
DK ..... 						8
[SPECIFY OTHER:] 			
A20.	Have you ever seen sewage on the pound around the	YES		 1
center?	NO	(GO TO A23)	2
DK	(GOTOA23)	8
A21. How many times did this happen last year?	I I 1 I Times/Tear
A22. On the average about how many days each time did	1111 Days/Time
the sewage stay on the ground around the center?
A23. In general, would you say the traffic condition near	Light (LESS than l car/5 min)	1
the center during your normal business hours is...	Moderate, or (1-4 CARS/3 MIN)	2
Heavy (5 CARS OR MORE/5 MIN) 	3
A24. About what time during the day do you think there is	——
the most traffic near the center?		_____
Ml wnr£FADA mrORMSWKE-ai.EFA	PAGE 6	02/tMJ
-------
The Environmental Study
Prt-Monkorlng Queationnfllrt/Day Care Center
SECTION B
GENERAL INFORMATION ON CENTER STAFF AND THE CENTER
Bl, Does any of your staff, including yourself, smoke	YES					1
cigarettes, cigars, or a pipe on a regular basis, at work	NO .......  A. V»»v^*r I UJF JLtJJEl< \JJLdL#
MENUS FOR THE ENTIRE 1996 (BRING THEM
BACK TO OUR OFFICE).
S: I WPSI WADa YKXFORMS, PXE-QI .FM
PAGE 7
02/ta/ai
-------
The Environmental Study
Fre-Monltorlng Questionnaire/Day Care Center
B8.


B9.


What kind of cooking devices are used to cook
or heat the food at the center?
How often is (DEVICE) used to cook or heat the food?
DEVICE
# Times
per
Day
Week
Month
Don't Know
1
I 1 1
1
2
3
8
2
1 I I
1
2
3
8
3
i 1 1
1
2
3
8
4
i 1 1
1
2
3
8
5
1 1 1
1
2
3
8
BIO. What are the sources of water for cooking
at the center?
CIRCLE ALL THAT APPLY
CITY 					1
WELL					2
BOTTLED 					3
OTHER (SPECIFY) 		4
SPECIFY:
B11. What kind of containers does the center use to
serve snacks, breakfast and/or lunch to the
children? If forks and spoons are used, please
also teU me what they are made of. Are they... CIRCLE ALL THAT APPLY
1.
2.
3.
4.
5.
6.
7.
8.
9.
TYPE
CUPS
PLATES
FORKS/SPOONS
Disposable
1!
o
z;
i
IE
S
YES = 1 NO =2
YES=1 NO=2
Non-disposable
YES=1 NO=2
YES=1 NO =2
YES = 1 NO=2
Paper
YES=1 NO=2
YES=1 NO =2
YES = 1 NO=2
Plastic
YES=1 NO=2
YES=1 NO =2
YES = 1 NO=2
Styrofoam
YES=1 NO=2
YES = 1 NO—2
YES—1 NO-2
Glass
YES=1 NO=2
YES = 1 NO =2
YES=1 NO =2
Stainless steel
YES—1 NO=2
YES = 1 NO =2
YES=1 NO=2
Aluminum
YES=1 NO=2
YES=1 NO =2
YES=1 NO =2
Any other kinds (SPECIFY)
YES=l NO=2
YES=1 NO =2
YES=1 NO=2
SPECIFY:
iVrt WTSl \EtABA nPJ>ORMS\PH£-Ql.ErA
page s
02/ta/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Cart Center
B12. What are the sources of drinking
water for the center?
CIRCLE ALL THAT APPLY
CITY 					 				1
WELL						2
BOTTLED			3
OTHER (SPECIFY) 						4
SPECIFY:.
B12. Do you filter the drinking water at the	YES					1
center?	NO						 2
Now I have some questions about how the center is cleaned on a regular basis.
B13.
How often is the floor of the center ...

i Times per
Day Week Month Don't Know
a. sweep-cleaned?
1 1 1
1 2 3 8
b. vacuum-cleaned?
I 1 i
1 2 3 8
C. wet-mop-cleaned?
I 1 1
12 3 8
B14. Does the center have any pets?
YES	
NO	(GO TO BIT)
1
2
B15. What kind of pets does the center have?
B16. Do you keep them inside or outside the center?
Inside .
Outside
Otter .
1
2
3
[SPECIFY OTHER:]
B17. Did anyone in your center change automobile oil in the
parking lot or driveway during the past year?
YES	
NO		 . (GO TO B20)
1
2
B18. How many times did this happen (changing automobile oil
in the parking lot or driveway) during the past year?
! Times
N:XWPSl\£PABAYK'fORMS\PItE-QLEPA
PAGE 9
Q2/18/97
-------
The Environmental Study
Pre-Monitortag Questlonnaire,,Dav Care Center
B19. How did they dispose of the automobile oil?
B20. How does the center dispose of the garbage?
B21. What months of die year does the center usually close all of the exterior doors and windows because the heating or
air conditioning is running? [READ EACH MONTH:]
la	Hs
a.	January				1	2
b.	February 						1	2
c.	March						1	2
d.	April 					1	2
e.	May 					1	2
f.	June 					1	2
g.	July 				1	2
h.	August					1	2
i.	September 							1	2
j. October 					1	2
k. November 					1	2
1. December		1	2
m wpsi \£rADAm>omnem-ui.£PA
PAGE 10
oi/imi
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
Now I have a few questions about some commercial chemical products that may be used in your center.
[IF B22=YES, ASK B23-B26; IF B22=NO, ASK NEXT CHEMICAL.]
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION®, USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
a. Paint removers
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3 = MONTH 4=YEAR
DATE:
WHERE:
b. Water-based paints
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAM E.-
Tel:

1 1 1 Times per
1=DAY 2 = WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
c. Oil-based paints
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 .1 Times per
1 = DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N:\WPS11EPADA mFORMSWRE-Ql.EPA
PAGE 11
01/ISM7
-------
The Environmental Study
Pre-Monltoring Questionnaire/Day Care Center
B22.
B23.
B24.
B25.
B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? if
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION(S), USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
d. Stains/varnishes
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
e. Wood deck preservatives
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
f. Weed killers
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

I	1—1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N:\WPS I \EPADA YK\FORUS\PKE-QI.EPA
PAGE 12
02/1 Srtl
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION(S), USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
g. Insecticides or pesticides (to
kill insects, rodents, etc.)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 ...J	1 Times per
1=DAY 2=WEEK
3 = MONTH 4=YEAR
DATE:
WHERE:
h. Fungicides (to kill fungal
growth and mold)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

I. J—1 Times per
1=DAY 2=WEEK
3 = MONTH 4=YEAR
DATE:
WHERE:
N:\WPSIlEPADAmFOKMS\PRE-QI.EPA
PAGE 13
02/tart7
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION(S), USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
i. Disinfectants (Lysol, etc.)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
j. Detergents/soaps
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3 = MONTH 4=YEAR
DATE:
WHERE:
k. Degreasers (for car/engine
repair)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

I... 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4 = YEAR
DATE:
WHERE:
N:\Wril\EPADAYIC\FOKMS\PRE-Ql.EPA
PAGE 14
02/tdrt7
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION(S), USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
1. Kerosene
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3 = MONTH 4=YEAR
DATE:
WHERE:
m. Lighter fluid
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1 = DAY 2=WEEK
3 = MONTH 4=YEAR
DATE:
WHERE:
n. Charcoal
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3 = MONTH 4=YEAR
DATE:
WHERE:
o. Natural gas
NAME:
1
2
CI
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N:\WP5I \EPADA YK\F0RMS\PRE-Q1 .EPA
PAGE IS
02/I&T37
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
SECTION C
CHILD ACTIVITY INFORMATION
Now I am going to ask you some questions about the daily activities of the children in your center during the past month.
Since the air monitor Is installed in the (4 - 5/OR THE ACTUAL ROOM) years old classroom, the following questions only
aoolv to the children in that classroom.
CI. Does the classroom have a daily activities schedule?
IT YES, ASK FOR A COPY OF THE SCHEDULE
FOR THE CLASSROOM THAT IS BEING
MONITORED.
C2. Did your staff (the teachers in that classroom) pretty
much follow the daily activities schedule?
C3. Did you allow the children walking barefoot INSIDE
the center?
C4. Did you allow the children walking barefoot OUTSIDE
the center?
YES
NO .
(GOTOC3)
YES				 1
NO			2
YES	1
NO				 . 2
YES			1
NO	2
C5. About how many hours of nap time a day did the
children have at the center?
NO NAP TIME = 00
HOURS/DAY
[SEP TO C8 IF NO NAP TIME]
C6. Did the children sleep on the floor?
[IF NO, ASK WHERE AND THEN SKIP TO C8]
YES	
NO	(WHERE)
1
2
WHERE:
CI. Was there a mattress, a pad, or a beach towel (to place
on the floor) for every child when they took a nap?
YES
NO .
(EXPLAIN)
1
2
EXPLAIN:
N:\WPS! IEFADA mFORMSWRE-Qi.StA
PAGE 16
02/f 3/3?
-------
Hie Environmental Study
Pre-Monltoring Questionnaire/Day Care Center
C8. About how many hours a day did the children stay	1 I I
outside the center (playing in the playground or out on	hours/day
a field trip, etc.)? Again, we are talking about the past
month.
C9. When the children played outside the center, would	YES			1
they frequently come in contact with the soil?	NO			2
CIO. Where did the children usually play outside the center?
MARK ON THE SKETCH
C11. About how many hours a day did the children stay	I I I
inside the center?	HOURS/DAY
C12. How often were the hands of the children washed	Always 	1
before eating snacks? Would you say...?	Most of the time 			2
Sometimes, or ....... 			 3
Rarely 			 4
NA 				5
DK			.8
€13. How often were the hands of the children washed	Always 		 . . 			 1
before eating breakfast and/or lunch? Would you	Most of the time 				2
say...?	Sometimes, or		 . 3
Rarely			4
NA	5
DK	8
€14. How often were the hands of the children washed after	Always 			1
playing outside? Would you say...?	Most of the time 			2
Sometimes, or ... 		3
Rarely 			 4
NA	5
DK			8
miWKitErADAmFomsvits-Qi.a'A
PAGE 17
02/18/37
-------
The Environmental Study
Pre-Monltarint; Questionnaire/Day Care Center
CONCLUDING STATEMENT
Thank you very much for your time, (Mr./Mrs./Ms.) (RESPONDENT'S LAST NAME). That concludes our interview for
today. We really appreciate your willingness to answer our questions and to participate in this important study. You've
been very helpful. As we told you earlier, the air monitors will run for about 48 hours. We may stop by tomorrow to check
the air monitors.
We'll see you again on (DAY	.DATE: / ) around (TIME: 	AM IPM) to remove the air monitors.
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS
SOON AS POSSIBLE.
DISCUSS THE FOOD SAMPLE COLLECTION INSTRUCTIONS WITH THE RESPONDENT.
mwrsi >SPADA nCfOXMSWKEQi.EPA
PAGE 18
QVl W7
-------
The Environmental Study
Post-Monitoring Questionnaire
(CHILD DAY CARE CENTER)
1997
PARTICIPANT ID#: I l-l II
-------
INTERVIEW INFORMATION
PARTICIPANT ID #: I 1-1 1 1
RECORD:
0 1
SUBRECORD:
0 0
VERSION:
0 1

INTERVIEWER
ID#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
I 1 1
II 1! 1 III 1


COMPLETE 	1

MM DD YY


INCOMPLETE	2
02
I 1 !
1 III 1 II 1 1


COMPLETE 	1

MM DD YY


INCOMPLETE	2
03
L 1 1
1 MI 1 11 1 1


COMPLETE 	1
INCOMPLETE	2
t ,, . i, ,,.J
MM DD YY


04
1 1 I
1 1 II 1 II 1 1
' I " AW ' PM

COMPLETE ..... 1
INCOMPLETE ....2
l__!	1
MM DD YY


REASONS FOR NONCOMPLETION:
01
02
03
04
RESPONDENT'S COOPERATION WAS:	VERY GOOD					 1
GOOD 		 		2
FAIR 					 3
POOR				4
THE OVERALL QUALITY OF THIS	HIGH QUALITY 			 1
INTERVIEW WAS:	GENERALLY RELIABLE 			2
QUESTIONABLE	 (SPECIFY BELOW). . . 3
UNSATISFACTORY	 (SPECIFY BELOW). .. 4
REASON(S) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
02/18/37
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center
I would like to ask you some questions about the daily activities of the children in your classroom during the 48-hour air
monitoring period, that is from	to	. First,
1. Did the children do anything during the 48-hour period that brought them near any of the following materials, places, or
activities?
MATERIALS, PLACES, OR ACTIVITIES
YES
NO
IF YES, WHERE
a. freshly applied paint 		
1
2
-
b. food being fried, grilled, or barbecued	
1
2

c. burning of rubbish, garbage, or yard waste . 		
1
2

d. other open flames, including barbecue flames, fires ....
1
2

e. glues or other adhesives 	
1
2

f. solvents, fumes, or odorous chemicals 		
1
2

g. floor wax, furniture wax, or shoe polish 		
1
2

h. gasoline- or diesel-powered equipment other than
automobiles, including lawn mowers 		
1
2

i. household cleaning agents, such as scouring powders or
ammonia ... 	 			 . , , , 	 „
1
2

j. excessive dust in the air 		
1
2

k. stain or spot removers 		. . .		
1
2

1. gas station or auto repair shop 		
1
2

m. around where someone was pumping gasoline 	
1
2

n. around a gas range or oven when it was used	
1
2

o. around a microwave oven when it was used	
1
2

p. freshly applied insecticides or pesticides (used to kill
insects, rodents, etc.) 	
1
2

q, freshly applied herbicides such as weed killers (in farm
fields or gardens) 			
1
2

r. roofing tar or road tar 			
1
2

s. around someone who was changing automobile oil ....
1
2

t. Fungicides (to kill fungal growth and mold) 		
1
2

u. Disinfectants (Lysol, etc.)		
1
2

v. Detergents/soaps					
1
2

mwpsiwPADArKVomswosr-Qi.EPA
PAGE 1
02/1W97
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center
MATERIALS, PLACES, OR ACTIVITIES
YES
NO
Tl? V¥PC WTTiTTJl?
JLr IrVJtXJELJfcvJcL
w. Degreasers (for car/engine repair)	
1
2

x. Kerosene			
1
2

y. Lighter fluid	
1
2

z. Charcoal			
1
2

aa. Natural gas 			
1
2

2.	3.
Was any of the following (heating system/heater) used in this
classroom during the 48-hour period? IF YES, ASK #3.
About how many hours a day during the 48-hour
period was it used?
HEATING SYSTEM/HEATERS
YES
NO
a. Central electric
e. Fireplace
f. Wood stove
j. OTHER (SPECIFY)
h. OTHER (specify)
i. OTHER (specify)
d. Electric space heater
c. Kerosene space heater
b. Central gas
f/:lWPll
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center
Did anyone smoke cigarettes, cigars, or a pipe inside the
classroom during the 48-hour period?
YES		 1
NO		 (GO TO 6)		 . 2
5, About how many cigarettes, cigars, or pipesful of tobacco
were smoked inside the classroom during the 48-hour
period?
_u
CIGARETTES CIGARS
PIPES
6. Did someone sweep or vacuum the floor or rugs
inside the classroom during the 48-hour period?
YES
NO .
7. Have you seen any children in your classroom suck	YES	1
their thumbs or fingers during the 48-hour period?	NO	2
8. Have you seen any children in your classroom chew
their finger nails during the 48-hour period?
YES
NO .
1
2
9. Have you seen any children in your classroom put
toys in their mouths during the 48-hour period?
10. Have you seen any children in your classroom walk
barefoot inside the center during the 48-hour period?
11. Have you seen any children in your classroom walk
barefoot outside the center during the 48-hour period?
YES 						1
NO			2
YES		 1
NO			2
YES		 . 1
NO	2
12. During the 48-hour monitoring period, about how
many hours of nap time a day did the children have at
the center?
NO NAP TIME = 00
HOURS/DAY
[SKIP TO C15 IF NO NAP TIME]
13. Did the children sleep on the floor?
[IF NO, ASK WHERE AND THEN SKIP TO C15]
YES
NO .
(WHERE)
1
2
WHERE:
N:\WMi WADAYX\FOI!MS\POST-QI .EPA
PAGE 3
02/18/97
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center
14. Was there a mattress, a pad, or a beach towel (to place	YES				 1
on the floor) for every child when they took a nap?	NO		 (explain)	2
EXPLAIN:
15.	During the 48-hour monitoring period, about how	1 I I
many hours a day did the children stay outside the HOURS/DAY
center (playing in the playground or went to a field
trip, etc.)?
16.	Did the children play outside and contact with dirt or	YES 				1
soil during the 48-hour monitoring period?	NO					2
17. Where did the children usually play outside the center?
MAW am TUU CTTfTm
lVUVKlv UIN
18.	During the 48-hour monitoring period, about how	1 I I
many hours a day did the children stay inside the hours/day
center?
19.	During the 48-hour monitoring period, how often were	Always 				 1
the hands of the children washed before eating snacks?	Most of the time 	2
Would you say...?	Sometimes, or	3
Rarely	.4
NA . , . .					5
DK			8
20.	During the 48-hour monitoring period, how often were	Always 			1
the hands of the children washed before eating	Most of the time 	2
breakfast and/or lunch? Would you say...?	Sometimes, or		 3
Rarely	4
NA ......... 		5
DK . . 				8
.V: 1 wni \ETADA YKifORMS rOST-Qi. EPA.	PAGE 4	02/18/97
-------
The Environmental Study	Post-Monitoring Questionnaire/Day Care Center
21. During the 48-hour monitoring period, how often were	Always 			1
the hands of the children washed after playing outside?	Most of the time 			 2
Would you say...?	Sometimes, or .......... 		3
Rarely	4
NA			5
DK					.8
22.
23,
Did the teacher wash the children's hands each time or
the children did it by themselves?
Was soap always used when washing the children's
hands?
Washed by the teacher	1
Washed by the children	2
Sometimes by the teacher
and sometimes by the children	3
YES		 1
NO		 , (GO TO 25) ... 		2
24. What kind of soap do you usually use in the classroom?
SPECIFY BRAND NAME AND LIQUID SOAP OR
BAR
25. Was any detergent or disinfectant used regularly to
clean the tables or the floor in the classroom?
YES
NO .
			1
(GO TO 27) ......... 2
. 26. What kind of detergent or disinfectant do you usually
use in the classroom?
SPECIFY BRAND NAME
27.	Do you mind if I take a look at the children's finger nails?
(Children's finger nails may be a factor contributing to the potential exposure of pollutants.)
GIVE EVERY CHILD A STICKER.
EXAMINE THE CHILDREN'S FINGER NAILS AND RECORD THE RESULTS IN THE
WORKSHEET IN PAGE 6.
LATER PUT THE TOTAL COUNTS IN THE FOLLOWING TABLE.
Number of children with...
A. Dirty finger nails:
B. Clean finger nails
TOTAL
1. Long finger nails:



2. Short (recently cut) finger nails



TOTAL



mwrsmPADAmFoms\msT-Qi.EPA
Page 5
02/18/97
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center
WORKSHEET FOR ill
FOR EACH CHILD, CHECK EITHER L OR S; D OR C.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
L















S















D















C















OR S; D OR C

16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
L















s















D















c















N:WPSl\EPADAYX\FOms\POST-Ql.EPA
PAGES
02J1S/97
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center
CONCLUDING STATEMENT
Thank you very much for your time, (Mr./Mrs./Ms.) (RESPONDENT'S LAST NAME). That concludes our Interview for
today. We really appreciate your willingness to answer our questions and to participate in this important study. You've
been very helpful. Do you have any questions or comments?
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS SOON AS
POSSIBLE.
W.-l WPS l WPADA nC\FOMMS\mST-Ql.El'A
PAGE 7
0S/1SJS7
-------
Day Care Location & Surrounding Area
ID: D01
HP Soil sampling location
OM Outdoor air monitor
North.
# -y % >-¦, £
» * Kr*-f 1W»«
Back
Front
D1 First dust sample area.
.iDC.,; S«cond dust sample axe a.
jjj Indoor air monitor locition
7
Selected. Ckuiocm
-------
Day Care Location & Surrounding Area ID: D02
' Soil sampling location
|OM| Outdoor air ironrtor
North

First dust sample ansa
Second dust sample area.
*NOTE: Soil sample also was
taken from a raeaifey city park
where the children played during
the 48-keui sampling period.
Float ofBaildng
%
Playground
Indoor air monitor location
71
Selected Classroom
IM
On the second floor of the building
-------
Day Care Location & Surrounding Area
ID; D03
j*J Soil sampling location
OM Outdoor air monitor
North
^3-
5F

t w
OM Back
PirkiiL; Lot
Fust dust sample area
SjQ'i Second dust sample area
'jsfjfr*
mg! Indoor air monitor locat ion
Hallway
V
m
&£>"
Selected Classroom
EM
/
Back ofbulding
-------
Day Care Location & Surrounding Area
ID: D04
Hp Soil sampling location
OM Outdoor «r monitor
North
(balowtfte
-------
Day Care Location & Surrounding Area
ID: D05
Hp Soil sampling location
North
OM Outdoor air monitor
k# *s> «*b m
l&wfc^SNfc ? »i>JgF -#f





fT\



PliygKiUJld
Pli/KTCUiKi

L
ranting Lot
* 3
Street
WW,P-
5jg^aggs!
DI i First dust sample area
Second dust sample area
'
-------
Day Care Location & Surrounding Area
ID: DO6
(§5 Soil sampling location
North
OM Outdoor air monitor
/ji i" ¦
¦k	7-8* •••; * #4 :---
-*"¦,:ds
|%i A'm



KvV'V ^ v7??
T>? ; •!',• &'•#'
direst
•%V- 4
stairs
Back
g Lot

*5' V5

. D1.¦ Fixst dost sample area
B2 Second dust sample aiea
jM® Third dust sample area
PI Indoor air monitor location
LP
I» D1
Selected Clawrcom
-------
Day Care Location & Surrounding Area ID: DO7
(J) Soil sampling location
North 4—0-
OM] Outdoor air monitor
Mm nun
iT I
% §?•$ 4 ^staL
-
Construction Site
(lower lev*!)
1

w §£
#C ' '$T 'y	«* ;..> * £•


r&s&saM:
fit f ,
#	J, ^ £ C|'
%• < J IJL
1 f 1 i
•?*• *'$/ * ? I <^r
tw; i ^
A'% s> Wf
f^'fS I
jj?_ ? a S.
^p| First dost sample wt
D3 Second dust sample area.

Third dust sample area
jjyj Irixfoor air monitor location.
IM
Selected Classroom
On tke second floor of the building
-------
Day Care Location & Surrounding Area
ID; D08
# Soil sampling location
QM Outdoor iit monitor
-ji >c-ti *j
North

^ riilM!
Bam i
a "

%%s£
«fefe 4
¦
W;§ '\1= "t
*
Sr rjt	•»
iS#fi;-s >
jfl
ft 4£* J
&
flit
v-"-^ *?n|i
Parkuv. Lot
«
' , *»•
DI First dust sample area
IK _ Second, dust sample area
Uj Indoor air monitor location
EM
Left Side
Building
€1
Hallway
Selected Classroom
-------
Day Care Location & Surrounding Area H); D09
©
North
Soil sampling location
|OM| Outdoor iir monitor

y Pbv?rcard

-'-r	%
C
"i,
-IS1
'W A	** * "#1 ;\ £
1 *¦-	A % «l£t1*3b"	; •¦aft),?'
4 ^ ¦
' * !?
**'* ¦};;¦:¦
, a-VvT'
i-'w,^v4-4'5'
Piaygrounl >
/'* #
• W\ ® •'« ^ -c»
•»: $ ••'»"¦' *$tf=C5s
"r *« «,* * '•'••••!* ;'w 'l %
k"- •*» V ?-¦ 4,y.» ... ^
<» s ..*iii~. -t .gfif'.*	¦¦'. v *
	:

Deck
/
OM




Ik
1

Building M2


fm.
...


Puking Lot
Fp nt
Parking Lot
.~a*ea
IX) I Hzd dust saxnpk area
# Fourth dust sample ars»
Decl
c
Hallway
Old Caipet Ckssroom
m m
.

nvi
m D1
"I #
N«w Capei Qaiimozn
Hallway
-------
Day Care Location & Surrounding Area
ID: D10
® Soil sampling location
OM Oitdooi air ntomtor
H'M

'iVCoi,3liuc4io11
... 	


CorMr&Mio

•»• a
Entian :e
* S*
Front
[)I j First iust sample area
Ififc Second dost sample aw&
jjj Indoor air monitor location
EVI
Selected Classroom
	 1	
On the second floor of the Vuilding
-------
APPENDIX C. PHASE 2 FIELD STUDY:
Consent Form
Recruiting Materials
House/Building Characteristics Observation Survcy/'Daycare
House/Building Characteristics Observation Survey/Household
Pie-Monitoring Questi onnaire/D aycare
Pre-Monitoring Questionnaire/Household
Post-Monitoring Questionnaire/Daycare
Post-Monitoring Questionnaire/Household
Child Activity Diaiy/Daycare
Child Activity Diary/Household
Sketches of Daycare Centers
C-l
-------
THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 1 OF3
PARTICIPATION CONSENT FORM	LJ - L±J
The Environmental Study - Parents
ABOUT THE RESEARCH STUDY
The Batrelle Memorial Institute (Battelle), under a contract with the U.S. Environmental Protection Agency
(EPA), is conducting an environmental study in the research triangle area. North Carolina. The purpose
of this study is to develop methods for measuring possible pollutant exposure among children of pre-school
ages. With your help, our scientists may be able to develop ways for measuring pollutant exposure among
young children, which may benefit the health of young children in the future. Parents of the children in
the day care center were contacted and about five parents will be selected to participate in this study.
DO I HAVE TO PARTICIPATE IN TOE STUDY?
You do not have to participate in this study, participation is totally voluntary. You are free to withdraw
your consent and stop participation in the study at any time. You may also choose not to answer any
particular questions asked during the interview. Participation in this study does not mean that dangerous
levels of pollutants are present in your area. There is no experimental procedure involved in the study and
there is no risk to your child/children or other members in your household. The information we collect
will be used only for the purpose of this study. The researchers conducting this study are committed to
protecting the privacy of all participants. Except for the research staff directly involved in the study, no
one will be able to identity you or the day care center from the records or reports produced from this
study. The identifying information will be kept by Battelle and will be destroyed when the study is
completed. No personal names or names of the day care centers will be identified in the reports, and no
individual data will be available to anyone requesting the information. Participation or withdrawal from
participation will not affect any benefits you may receive. The study results will be available to you if you
request them. There is no direct benefit for you to participate in the study. But if you can participate, you
may help us develop methods for measuring pollutant exposure of young children, which may benefit the
health of young children in the future.
Your participation is very important to the success of this study. Each household was selected through a
scientific procedure. It is very difficult to replace a household which has been selected for this study. To
compensate for your time and assistance, we will pay you $50 after you complete all study activities.
WHAT DO I NEED TO DO TO PARTICIPATE IN THE STUDY?
If you agree to participate, we will schedule an appointment with you at your convenience to conduct the
following activities:
1. Install an air monitor inside your home and an air monitor outside your home. The
purpose of installing the air monitors is to collect air samples in and around your home.
You will not have to watch these monitors. There is no risk or danger to your family.
They will be plugged into an electric outlet in your home. When the monitors are
running, they use very little electricity (it costs about 60 cents a day to run the monitors),
and you may hear some noise like a small fan. We will put the indoor air monitor in a
playpen (we will bring the playpen). The air monitors will be set up to run for about 48
hours.
N:\ WPS HE?ADA YICJRB\DA YKCON3. EPA
February 2S. 1997
-------
THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 2 OF 3
2.	Draw a sketch of the floor plan of your house which will be used to mark the location of
the air monitors.
3.	Ask you some general questions about your house and the daily activities of your child.
If you prefer, we may collect this information through a telephone interview with you at
a time that is convenient for you. This will reduce the amount of time that we have to
meet with you at your home.
4.	Give you a simple diary to record your child's activities during the 48-hour air monitoring
period.
5.	Ask you to help us collect some samples of the foods that your child had eaten during the
48-hour air monitoring period. We will provide containers and show you how to collect
the food samples. We will also ask you to write us a note for the food items that were
collected.
6.	Ask you to help us collect some urine samples of your child at home during the 48-hour
air monitoring period. We will provide containers and show you how to collect the urine
samples.
~ Please note that we will also ask your child's teacher at the day care center to help us
collect some urine samples of your child at the dav care center during the 48-hour air
monitoring period.
7.	Ask you to help us coEect 2 hand-wipe samples of your child at home during the 48-hour
air monitoring period. You will need to use a cleaning pad to wipe the forearms of your
child before he/she takes a bath. We will give you the cleaning pads and show you how
to do it.
~ Please note that we will also ask your child's teacher at the day care center to help us
collect 2 hand-wipe samples of your child at the day care center during the 48-hour
air monitoring period. The teacher will do this before lunch time.
We will only need about 30 minutes of your time to complete the interview with us. Our research staff
should complete all of the above activities in about an hour. We will schedule another appointment with
you two days after our first visit to remove the air monitors. We will conduct the following activities
during our second visit:
1. Remove the air monitors.
2.	Collect some dust samples (using a vacuum) inside your tome and take some soil samples
around your home.
3.	Pick up the child activity diary, urine samples, hand-wipe samples, food samples, and your
note for the food items that were collected.
4.	Ask you some questions about your child's daily activities during the 48-hour air
monitoring period.
5.	Give you a certificate to thank you for your participation.
N: IWPS1 \£PADA YKMRB IDA YKCOH3. EPA
February 28, 1997
-------
THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 3 OP 3
It will only take about 20 minutes of your time to complete the interview with us. Our research staff should
complete all of the above activities in about an hour, A $50 check will be mailed to you within two weeks
after you complete all study activities. Please feel free to ask questions. If our staff can not answer your
questions, we will forward the questions to the investigators. If you have any questions about this study,
you may call Christopher Lyu, Study Manager, at (919) 544-3717. If you have any concerns about your
rights as a research participant, you may call Dr. Margaret Pennybacker, Chairperson of the
Battelle/CPHRE Institutional Review Board, at (919) 544-3717.
INFORMED CONSENT
I have read this 3-page consent form or it has been explained to me. I understand that my participation will
involve all of the activities described in this consent form. I have been given the chance to ask questions
and my questions have been answered. My signature below means that I have freely agreed to participate
in this study.
Please Print Your Name	Your Signature	Date
Please Write Child's First Name and Age Here:
Name:	 Age:_
Study Staffs Signature	Date
N:\WP51 \EPADA YKSIRB\DA YKCON3.EPA
February 2M, 1997
-------
THE ENVIRONMENTAL STUDY
PARTICIPATION CONSENT FORM
CONSENT FORM PACE I OF 3
U-L_U
The Environmental Study - Phase II
ABOUT THE RESEARCH STUDY
The Battelle Memorial Institute (Battelle), under a contract with the U.S. Environmental Protection Agency (EPA),
is conducting an environmental study in the research triangle area, North Carolina. The purpose of this study is to
develop methods for measuring possible pollutant exposure among children of pre-school ages. Your center was
one of the nine day care centers that participated in the first phase of this study about three months ago. We have
selected two of the nine day care centers to participate in the second phase of the study. The purpose of the second
phase study activities is to validate the data collection methods we used earlier.
DO I HAVE TO PARTICIPATE IN THE STUDY?
You do not have to participate in this study, participation is totally voluntary. You are free to withdraw your consent
and stop participation in the study at any time. You may also choose not to answer any particular questions asked
during the interview. Participation in this study does not mean that dangerous levels of pollutants are present in your
area. There is no risk to the children or staff in your day care center. Except for the research staff directly involved
in the study, no one will be able to identify you or the day care center from the records or reports produced from
this study. The identifying information will be kept by Battelle and will be destroyed when the study is completed.
No personal names or names of the day care centers will appear in the reports, and no information from your day
care center will be available to regulatory agencies or anyone else requesting it. The study results will be available
to you if you request them. There is no direct benefit for you to participate in the study. But if you can participate,
you may help us develop ways to measure pollutant exposure of young children, which may benefit the health of
young children in the future.
Your participation is very important to the success of this study. Each day care center was selected through a
scientific procedure. It is very difficult to replace a day care center which has been selected for this study. To thank
you for your time and assistance, we will pay you (or the day care center) $75 after you complete all study activities.
WHAT DO I NEED TO DO TO PARTICIPATE IN THE STUDY?
If you agree to participate, we will ask you to help us distribute letters to some parents of the children at your day
care center. The letter is similar to the one you received, which explains the purposes of the study and asks
interested parents to return a response note to your office. Our research staff will contact you a few days later and
collect the response notes. There will be 4 to 5 children of your day care center selected to participate in the study.
The selected children will be divided into 2 groups: Group A and Group B. About two weeks after we collect the
response notes from the parents, we will contact you and schedule our visits with you. There will be a total of 5
visits. We will visit you at a scheduled time each day to do the following activities:
First Visit (Monday)
1.	Install an air monitor inside the day care center and an air monitor outside the day care center. The purpose of
installing the air monitor is to collect air samples in and around the day care center. You will not have to watch
these monitors. There is no risk or danger to the children or your staff. They will be plugged into an electric
outlet in the day care center. When the monitors are running, they use very little electricity (it costs about 60
cents a day to run the monitors), and you may hear some noise like a small fan. We will put the indoor air
monitor in a playpen (we will bring the playpen). The air monitors will be set up to run for about 48 hours.
2.	Draw a sketch of the floor plan of the day care center which will be used to mark the location of the air
monitors.
N:\WPSI \EPADA YKMRB liM YKCONl.EPA
February 28,1997
-------
THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 2 OF 3
3.	Talk with the teacher of the selected children and ask some general questions about the day care center and the
daily activities of the children in that classroom.
4.	Ask you or the teacher to help us collect some samples of the foods that were provided to the selected children
(Group A) at the center during the 48-hour air monitoring period. We will give you containers and show you
how to do it. We will also ask you to give us a menu for the food items that were collected.
5.	Ask the teacher to help us collect some urine samples of the selected children (Group A). About 3 urine samples
for each child will be collected during the 48-hour air monitoring period. We will provide containers and show
the teacher how to collect the urine samples.
6.	Ask the teacher to help us collect 2 hand-wipe samples of the selected children (Group A). The teacher will need
to use a cleaning pad to wipe the forearms of the selected children before they eat their lunch during the 48-hour
air monitoring period. We will provide the cleaning pads and show the teacher how to do it.
We will need to talk with the teacher for about 20 to 30 minutes. Our research staff should complete all of the above
activities in about an hour.
Second Visit (Tuesday)
1.	Check the air monitors.
2.	Ask you or the teacher to help us collect some samples of the foods that were provided to the selects! children
(Group B) at the center during the 48-hour air monitoring period. We will give you containers and show you
how to do it. We will also ask you to give us a menu for the food items that were collected.
3.	Ask the teacher to help us collect some urine samples of the selected children (Group B). About 3 urine samples
for each child will be collected during the 48-hour air monitoring period. We will provide containers and show
the teacher how to collect the urine samples.
4.	Ask the teacher to help us collect 2 hand-wipe samples of the selected children (Group B). The teacher will need
to use a cleaning pad to wipe the forearms of the selected children before they eat their lunch during the 48-hour
air monitoring period. We will provide the cleaning pads and show the teacher how to do it.
The time we need to talk with the teacher is about 10 minutes. Our research staff should complete all of the above
activities in about 30 minutes.
Third Visit (Wednesday)
1.	Check the air monitors. The air monitors will be set up to run for another 48 hours.
2.	Pick up the urine samples, hand-wipe samples, food samples, and the menu for the food items that were collected
for the children (Group A).
3.	Ask the teacher some questions about the selected children's (Group A) daily activities during the 48-hour air
monitoring period.
The time we need to talk with the teacher is about 20 minutes. Our research staff should complete all of the above
activities in about an hour.
mWPSl\EPADAmm\DAYKCON2.EPA
Ftbnuuy 28, 1997
-------
THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 3 OP 3
Fourth Visit (Thursday)
1.	Check the air monitors.
2.	Pick up the urine samples, hard-wipe samples, food samples, and the menu for the food items that were collected
for the children (Group B).
3.	Ask the teacher some questions about the selected children's (Group B) daily activities during the 48-hour air
monitoring period.
The time we need to talk with the teacher is about 20 minutes. Our research staff should complete all of the above
activities in about an hour.
Fifth Visit (Friday)
1.	Remove the air monitors.
2.	Collect some dust samples (using a vacuum) inside the day care center and take some soil samples around the
day care center.
3.	Give you a certificate to thank you for your participation.
The time we need to talk with you is about 10 minutes. Our research staff should complete all of the above activities
in about an hour.
A $75 check will be mailed to you (or the day care center) within two weeks after you complete all study activities.
Please feel free to ask questions. If our staff cannot answer your questions, we will forward the questions to the
investigator. If you have any questions about this study, you may call Christopher Lyu, Study Manager, at (919)
544-3717. If you have any concerns about your rights as a research participant, you may call Dr. Margaret
Pennybacker, Chairperson of the Battelle/CPHRE Institutional Review Board, at (919) 544-3717.
INFORMED CONSENT
I have read this 3-page consent form or it has been explained to me. I understand that my participation will involve
all of the activities described in this consent form. I have been given the chance to ask questions and my questions
have been answered. My signature below means that I have freely agreed to participate in this study.
Please Print Your Name	Your Signature	Date
Study Staff's Signature	Date
N:\WPSl \EPADA YKVR31DA YKCON2.EPA
February 21, 1997
-------
, , . I'uiUnfi Tri htnilag'. To Work
May 5,1997
Centers for Public Health
Research and Evaluation
1 (X) Capitola Drive, Suite 301
Durham, North Carolina 27713-4411
Telephone (919)544-3717
Fax (919) 544-0830
Dear Parent:
I am writing to ask for your help with a research study currently being conducted by the Battelle Memorial Institute
(Battelle), a not-for-profit research organization. The purpose of this study is to develop methods for measuring
potential pollutant exposure among children of pre-school ages. Very little research was done in the past to
investigate the potential sources of pollutants and how young children may be exposed to pollutants. With your
help, our scientists may be able to develop effective methods for measuring pollutant exposure among young
children, which may benefit the health of young children in the future. This study is funded by the U. S.
Environmental Protection Agency.
Participation is voluntary. Your participation is very important to the success of this study. Each household will
be selected through a scientific procedure. It is very difficult to replace a household which has been selected for
this study. To compensate for your time and assistance, we will pay you $50 after the completion of all study
activities.
Participation will involve two brief interviews with our research staff and your permission to allow us to collect air,
dust, and soil samples from your home. In addition, we will need your help to collect some food samples and urine
samples of your child and to record a simple- diary of your child's activities during the 48-hour air monitoring
period. A detailed description of the study activities is provided in the enclosed Participation Summary. There will
be no costs to you for participation in this study. You are free to withdraw your consent and stop participation in
the study at any time. You may choose not to answer any particular questions asked during the interview.
Participation in this study does not mean that there are pollutants in your area. There is no experimental procedure
involved in the study and there is no risk to your child/children or other members in your household. The
information we collect will be used only for the purpose of this study. The researchers conducting this study are
committed to protecting the privacy of all participants. No personal names or names of the day care centers will
be identified in the reports, and no individual data will be available to anyone requesting the information.
Participation or withdrawal from participation will not affect any benefits you may receive. The study results will
be presented in an aggregate format only and will be available to you if you request it.
If you are interested in participating in the study, please complete the enclosed brief survey and return it to the
teacher of your child at the day care center by Tuesday, May 13,1997. After we receive your completed survey,
our research staff will contact you and tell you if your household is selected to participate in the study. We look
forward to talking with you and hope that you will be interested in participating in this important study.
Christopher W. Lyu.MPA
Sincerely,
Christopher W. Lyu,$£PA
Study Manager
mwsnePAZMraimifrrmPAfi
-------
Participation Summary
The study will be conducted sometimes during the first 2 weeks of June, that is, from June 2 to June 13, 1997. If you
agree to participate, we will schedule an appointment with you at your convenience to conduct the following activities:
1.	Install an air monitor inside your home and an air monitor outside your home. The purpose of installing the
air monitors is to collect air samples in and around your home. You will not have to watch these monitors.
There is no risk or danger to your family. They will be plugged into an electric outlet in your home. When
the monitors are running, they use very little electricity (it costs about 60 cents a day to run the monitors), and
you may hear some noise like a small fan. We will put the indoor air monitor in a playpen (we will bring the
playpen). The air monitors will be set up to run for about 48 hours.
2.	Draw a sketch of the floor plan of your house which will be used to mark the location of the air monitors.
3.	Ask you some general questions about your house and the daily activities of your child. If you prefer, we may
collect this information through a telephone interview with you at a time that is convenient for you. This will
reduce the amount of time that we have to meet with you at your home.
4.	Give you a simple diary to record your child's activities during the 48-hour air monitoring period.
5.	Ask you to help us collect some samples of the foods that your child had eaten during the 48-hour air
monitoring period. We will provide containers and show you how to collect the food samples. We will also
ask you to write us a note for the food items that were collected.
6.	Ask you to help us collect some urine samples of your child at home during the 48-hour air monitoring period.
We will provide containers and show you how to collect the urine samples. (•& Please note that we will also
ask your child's teacher at the day care center to help us collect some urine samples of your child at the day
care center during the 48-hour air monitoring period.)
7.	Ask you to help us collect 2 hand-wipe samples of your child at home during the 48-hour air monitoring
period. You will need to use a cleaning pad to wipe the forearms of your child before he/she takes a bath.
We will give you the cleaning pads and show you how to do it. (tV Please note that we will also ask your
child's teacher at the day care center to help us collect 2 hand-wipe samples of your child at the day care center
during the 48-hour air monitoring period. The teacher will do this before lunch time.)
We will only need about 30 minutes of your time to complete the interview with us. Our research staff should complete
all of the above activities in about an hour. We will schedule another appointment with you two days after our first
visit to remove the air monitors. We will conduct the following activities during our second visit:
1.	Remove the air monitors.
2.	Collect some dust samples (using a vacuum) inside your home and take some soil samples around your home.
3.	Pick up the child activity diary, urine samples, hand-wipe samples, food samples, and your note for the food
items that were collected.
4.	Ask you some questions about your child's daily activities during the 48-hour air monitoring period.
5.	Give you a certificate to thank you for your participation.
It will only take about 20 minutes of your time to complete the interview with us. Our research staff should complete
all of the above activities in about an hour. A $50 check will be mailed to you within two weeks after you complete
all study activities.
Mwnni&DtfWRaLETTBWw
-------
Thank you for your interest in participating the Environmental Study. Please complete this brief survey and return
it to us by Tuesday, May 13,1997. For your convenience, we have provided a self-addressed envelope and you
may return the completed survey to the teacher of your child at the head start center.
The information you provide in this brief survey will help us determine if your household meets the selection
criteria for participation. The information you provide will be kept confidential. If you wish, you may call us and
complete this survey with us over the phone. If you have any questions, please feel free to call Christopher Lyu,
study manager, or Frances Patterson, study supervisor, at (919) 544-3717. You may reach them between 9 a.m.
and 4:30 p.m., Monday through Friday. Our office is located in the Research Triangle Park, NC.
1.
What kind of heaters or heating systems do you use at
~
Central Electric Heat

home?
~
Central Gas Heat


~
Fireplace

(You may check more than one «$")
~
Wood Stove


~
Kerosene Space Heater


~
Electric Space Heater


~
Any Other (please specify):
2.
How many people in your household are smokers
~
None

(smoke cigarettes, cigars, or a pipe regularly)?
~
1


~
2

(Please check one «¦)
~
3


~
4


~
5 or more people.
3.
If you have smoker(s) in your household, what is the
~
No smokers in the household.

total number of cigarettes, cigars, or pipesful of
~
Only Smoke outside our home.

tobacco that are usuallv smoked inside vour home each



dav?

ciparettes/dav at home

(Please write down the numbers or check the

ciears/dav at home

appropriate response «")





pipesful of tobacco/day at home
4.
How many children aged 2 to 5 currently live in your



household? «"

Child (Children)
5.
Please tell us the first name and the age of the child



who is in the Head Start program.

Name: Are:

(If you have more than 1 child in Head Start, please



provide their names and ages)

Name: Ape:
6.
How many days per week does your child go to the



Head Start center?

davs per week at the center
7.
When does your child usually leave the Head Start



center each day? «"

Time leave the center:
OBairene
.. ,	"hdwmafx Ta Mtarfe
Page 1 of 2
-------
8.
Do you currently live in a	
~
One-Story House,


~
One-Story Duplex,

(Please check one bp)
~
Two-Story House,


~
Two-Story Duplex,

If Other Type, Please Specify:
~
One-Story Apartment,


~
Multiple-Story Apartment,


~
Trailer,


~
Mobile Home, or


~
Any Other Type (please specify)
9.
Is there an outdoor electric outlet at your home?
~
YES


~
NO
10.
How long have you and your family lived in your



current home? &

YEARS MONTHS
11.
Are you planning to move out of your current home
~
YES

within the next 30 days? **"
~
NO
12.
If your household is selected for the study, when

Days (Monday - Thursday):

would be the best times for us to visit your home to set



up the equipment? (An adult needs to be present when

Times:

we visit your home)


13.
What was vour total household income last year?
~
Less than $16,000


~
Between $16,001 and $25,000

(Please check one «sr)
~
Between $25,001 and $32,000


~
Between $32,001 and $50,000


~
More then $50,000
14.
How many people (including yourself) were supported



by that income? "

PEOPLE
15.
Does anyone in your household currently receive



public assistance (such as food stamps, AFDC, WIC,
~
YES

or any other government supports)? «s"
~
NO
16.
Please give us your name and contact information.


a*
First Name:
Last Name:
w
Home Address:


m-
Citv:
7.TP Code:
"B
Home Phone:
Work Phone:
©
Best Times to Call You:


©Baltelle
.., PMtOnt TmchmMagy To VKw#
Page 2 of 2
-------
An opportunity to contribute to an
environmental study and receive $50
J v
If your child will be attending the extended Head Start
Program at the Garner Head Start Center (that is, your
child will be at the center in June), your household may be
qualified to participate in an important environmental study
and receive $50 for your participation.
To find out more, you may get an information package from
Ms. Genita Raynor or you may call us at (919) 544-3717.
This is a local call if you call from Durham. You may call
the above number collect if it's a long distance call to you.
If you call us, please tell the receptionist that you have
questions about the environmental study. Our office hours
are 9 to 4:30, Monday through Friday.
If you like, you can give us your name and phone number and return this flyer to Ms. Raynor.
We will call you at your convenience.
Name:				 Phone No.: (	)___	
Best Times to Call You:	
-------
Thank You for Your Assistance! 1997
	Friday	Saturday
2 3 4 5 6 7
8 9
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30
1997 Schedule for
June
Sunday
Monday
Tuesday
Wednesday
Thursday
10
tit Environmental Study
Visit at 6:30 p.m.
« Christopher Lyu
(919) 544-3717
•Ct Environmental Study
Check outdoor air monitor
around 10:30 a.m.
You don't need to be at
home.
12
13
14
ft Environmental Study
Visit at 6:30 p.m.
Thanks David! ©
-------
Household
The Environmental Study
Instructions for Collecting Urine Samples
When to collect: The sample collection schedule is provided in the following Table. A
reminder is also included in the Child Activity Diary.
First Sample
2-3 hours after dinner or before go to bed
Second Sample
first thing in the morning, after your child wakes up
Third Sample
2-3 hours after dinner or before go to bed
Fourth Sample
first thing in the morning, after your child wakes up
How to do it: When your child needs to go to the bathroom,
1)	The adult puts on a clean pair of latex gloves (this is optional).
2)	Use the urine collector (Bonnet) to catch the urine.
3)	Immediately pour the urine into the urine container.
4)	Close the cap of the urine container tightly.
5)	Write down the date and time for the collected urine sample on the label of the urine
container.
6)	Rinse the Bonnet with clean water only. Do Not Use any soap or detergent to clean
the bonnet or urine container. If you did, it will cause problems to the sample
analysis.
7)	Discard the used gloves.
8)	Store the samples in your refrigerator or freezer (or in the cooler provided by us).
If you have any questions about the urine sample collection, please call Christopher Lyu, Study
Manager, at (919) 544-3717. Thank you very much for your assistance.
N\WP3!>£PADA rWOnM*UMN£jUXS
May /4 199?
-------
The Environmental Study
Instructions for Collecting FOO(l Samples
Household
1. When to collect: the samples should be collected during the following period of time:
From:			
To: 	
2.	What to collect: any foods and drinks (including water) that are given to your child at
home during the above period of time. Whenever it's possible, please remove the uneatable
part from the food samples (such as paper wraps, lollipop sticks, orange peel, chicken bones,
etc.).
3.	How much for the food sample: we need the same amount of foods and drinks
(including water) that your child eats and drinks at home during the above period of time.
If your child eats out (at a restaurant) or if you order carry-out (restaurant) foods, we also
need the same amount of foods and drinks that your child eats and drinks.
4.	Where to put the samples: we have prepared 2 glass jars for you; 1 for the solid foods
and the other for the liquid foods. Please separate solid foods (such as bread, meat,
vegetable, etc.) and liquid foods (such as milk, juice, and water).
Put solid food samples in the Glass Jar labeled Solid Food.
Put liquid food samples in the Glass Jar labeled Liquid Food.
5.	Please store the food samples in a refrigerator (or in the cooler provided by us). If you
have any questions about the food sample collection, please call Christopher Lyu, Study
Manager, at (919) 544-3717. Thank you very much for your assistance. •
N:\WP5fi£PADA mfORMStfOODJUm
May t4t 1997
-------
Day Care Center
The Environmental Study
Instructions for Collecting F 00(1 Samples
1. When to collect: the samples should be collected during the following period of time:
From: 	
To: 	
2.	What to collect: any foods and drinks (including water) that are given to the children in
the selected classroom (where the air monitor is installed) during the above period of
time. Whenever It's possible, please remove the uneatable part from the food samples (such
as paper wraps, lollipop sticks, orange peel, chicken bones, etc.).
3.	How much for the food sample: we need 1 regular serving for a child; 1 regular
serving is about the same amount of foods and drinks (including water) that a typical
child in the selected classroom eats and drinks during the above period of time,
4.	Where to put the samples: we have prepared 2 glass jars for you; 1 for the solid foods
and the other for the liquid foods. Please separate solid foods (such as bread, meat,
vegetable, etc.) and liquid foods (such as milk, juice, and water).
Put solid food samples in the Glass Jar labeled Solid Food.
Put liquid food samples in the Glass Jar labeled Liquid Food.
5.	Please store the food samples in a refrigerator (or in the cooler provided by us). If you
have any questions about the food sample collection, please call Christopher Lyu, Study
Manager, at (919) 544-3717. Thank you very much for your assistance.
f*:\WP5iS£PADA YK\FORM&FOOD_DCC WS
Afoy 14, iWt
-------
The Environmental Study
Instructions for Collecting Urine Samples
Day Care Center			
When to collect: The sample collection schedule is provided in the following Table. A
reminder is also included in the Child Activity Diary.
First Sample
about 2 hours after lunch
Second Sample
about 2 hours after lunch
How to do it: When the child needs to go to the bathroom,
1)	The teacher puts on a clean pair of latex gloves.
2)	Use the right urine collector (Bonnet) with the child's name on it.
3)	Use the right urine container with the child's name on it.
4)	Use Bonnet to catch the urine.
5)	Immediately pour the urine into the urine container.
6)	Close the cap of the urine container tightly.
7)	Write down the date and time for the collected urine sample on the label of the
urine container,
8)	Rinse the Bonnet with clean water only. Do Not Use any soap or detergent to clean
the bonnet or urine container. If you did, it will cause problems to the sample
analysis.
9)	Discard the used gloves.
10)	Store the samples in a refrigerator or freezer (or in the cooler provided by us).
If you have any questions about the urine sample collection, please call Christopher Lvu, Study
Manager, at (919) 544-3717. Thank you very much for your assistance.
N.\WF3i\ErAMrKfoiumixiNEj>c.ua
Ms? li. 1997
-------
The Environmental Study
House/Building Characteristics Observation Survey
(CHILD DAY CARE CENTER)
1997
PARTICIPANT ID#: Ll-I 1 I
-------
RECORD:
0 1
INTERVIEW INFORMATION
SUBRECORD:
PARTICIPANT ID #: LJ-L-L
VERSION:

INTERVIEWER
ID#
DATE
TIME STARTED
TIME ENDED
RESULTS
OF INCOMPLETE,
SPECIFY REASON)
01
1 1 1
II 11 Ml 1 1
1 1 I I 1 1 am ' PM
1 1 1 • 1 1 1 AM 'PM
COMPLETE 	i
MM DD YY
INCOMPLETE	2



02
1 1 1
1 Ml 1 11 1 1
MM DD YY
1 1 I)) 1 AM "PM
1 1 1 • 1 1 1 SU/PM
COMPLETE 	1
INCOMPLETE .... 2



03
1 I 1
1 Ml Ml II
II 1 . II 1 anm,
1 1 1.1 1 M,,,™,
COMPLETE 	1

MM DD YY


INCOMPLETE .... 2
04
1 1 1
1 Ml Ml II
1 1 I I 1 1 4M/PM
I I 1*1 1 I AM 'PM
COMPLETE ..... 1
MM DD YY
INCOMPLETE .... 2




REASONS FOR NONCOMPLETION;
01
02
03
04
N:\WP51 \EPADA YK\FQRMS\Q3S~Q1. EPA
Page 1
02/18/97
-------
SECTION A	HOUSE/BUILDING FLOOR PLAN
SKETCH THE INTERIOR OF THE HOUSE/BUILDING AND MARK AREAS SAMPLED WITH AN "X." USE A COMPASS
TO DETERMINE THE DIRECTIONS OF THE HOUSE AND MARK THE DIRECTIONS ON THIS SKETCH.
N:\WP5i\EeADAYKlFOilMMaS-Ql.EPA
Page 2
02/18/97
-------
SECTION B
HOUSE/BUILDING EXTERIOR
Bl. TYPE OF BUILDING STRUCTURE:	ONE-STORY HOUSE 	01
ONE-STORY DUPLEX 					02
TWO-STORY HOUSE					03
TWO-STORY DUPLEX					04
TRAILER/MOBILE HOME ....			05
APARTMENT 				 06
OTHER (SPECIFY)			07
REFUSED 		97
DK			98
[SPECIFY OTHER:] 		
12. BUILDING MATERIALS -ROOF:	METAL							1
WOOD SHINGLES OR PLYWOOD		 		2
ASPHALT SHINGLES			........ 3
OTHER (SPECIFY)					....... 4
[SPECIFY:] 	L_
B3. BUILDING MATERIALS - SIDING:	VINYL SIDING ONLY 						 . 1
BRICK ONLY 	2
BEADED SIDING	3
BLOCK					4
WOOD			.5
BRICK AND VINYL/BEADED SIDING 		 6
BLOCK AND VINYL/BEADED SIDING 				7
OTHER (SPECIFY)			8
[SPECIFY:] 	,	,	,		
B4. BUILDING FOUNDATION;	BLOCKS			....... 1
SLAB . 						2
CRAWL SPACE			3
BASEMENT 				4
OTHER (SPECIFY)		 5
[SPECIFY:] 	LJ
B5. IS THERE A FRONT PORCH/	YES . 					 1
BALCONY?	NO							... 2
B6. IS THERE A DECK OR TORCH/	YES				 . . . 1
BALCONY IN THE BACK OF THE	NO,...			2
HOUSEBUILDING?
MIWP31 \EPADA TKWOXMSWB^Ql.EPA
Page 3
ewm?
-------
SECTION B
HOUSEBUILDING EXTERIOR
B7. IS THERE A CONCRETE (OR PAVED)	YES						 . 1
DRIVEWAY?	NO	2
[IF NO. SPECIFY:] 	—
B8, IS THERE A CONCRETE (OR PAVED)	YES	...					1
WALKWAY FROM THE DRIVEWAY TO	NO . 							 		2
THE HOUSE/BUILDING?
[IF NO. SPECIFY:]
B9. CONDITION OF EXTERIOR STRUCTURE:
YES
a.	WELL MAINTAINED		 			 . 1
b.	PEELING PAINT 		 1
C. SIDING IN DISREPAIR 		 1
d.	PASTS OF SIDING OR ROOFING LYING IN YARD . . 1
e.	BROKEN WINDOWS			 1
f.	BROKEN DOORS	 1
g.GENERALLY	DETERIORATED 		 1
BIO. DESCRIBE THE AREA OUTSIDE IN YARD > 50% COVERED WITH LAWN, TREES, ETC.	1
FRONT OF THE HOUSE/BUILDING YARD > 50% BARE DIRT/MUD		2
{> =MORE THAN): YARD > 50% PAVED 						3
OTHER (SPECIFY)				4
[SPECIFY:]	~
Bll. DESCRIBE THE AREA OUTSIDE IN THE YARD > 50% COVERED WITH LAWN, TREES, ETC.	1
BACK OF THE HOUSE/BUILDING YARD > 50% BARE DIRT/MUD 					2
(> =MORE THAN); YARD > 50% PAVED 						3
OTHER (SPECIFY)					4
[SPECIFY:)		
B12. DESCRIBE THE AREA OUTSIDE ON	YARD > 50% COVERED WITH LAWN, TREES, ETC.	1
THE LEFT SIDE (YOUR LEFT WHEN	YARD > 50% BARE DIRT/MUD				2
YOU FACE THE BUILDING) OF THE	YARD > 50% PAVED 		3
HOUSE/BUILDING	OTHER (SPECIFY) 					4
(> =MORE THAN):
m
2
2
2
2
2
2
2
NAWP5I \EPADA YK\FORMS\OBS-QL£PA
Page 4
02/18/3?
-------
SECTIONS
HOUSEreun juno exterior
[SPECIFY:]
B13. DESCRIBE THE AREA OUTSIDE ON
THE RIGHT SIDE (YOUR RIGHT WHEN
YOU FACE THE BUILDING) OF THE
HOUSEBUILDING
(> =MORE THAN):
YARD > 50% COVERED WITH LAWN, TREES, ETC.	1
YARD > 50% BARE DIRT/MUD 			2
YARD > 50% PAVED 				3
OTHER (SPECIFY)		4
[SPECIFY:}.
D
B14. IS THERE ANY ODOR OUTSIDE? IF YES, DESCRIBE IT.
YES	E22
a.	FRONT OF HOUSE/BUILDING	 1	2
b.	BACK OF HOUSE/BUILDING	 1	2
c.	LEFT SIDE OF HOUSE/BUILDING 		 1	2
d.	RIGHT SIDE OF HOUSE/BUILDING	 1	2
[DESCRIPTION:]
B15. IS THERE STANDING WATER OR ANY	YES
DISCHARGE INTO THE YARD OR	NO
AROUND THE HOUSE/BUILDING?
(SUCH AS DISCOLORED WATER/ MUD,
ETC. FROM INDUSTRIAL, SEWAGE,
OR HOUSEHOLD WASTE)
PF YES. CAN YOU SEE WHERE IT'S COMING FROM:]
B16. IS THERE EVIDENCE THAT RUBBISH	YES					1
BURNING WAS DONE ON THE	NO	2
PROPERTY?
[IF YES, DESCRIBE:]
B17. IS THERE EVIDENCE THAT GARBAGE	YES . 								1
WAS DUMPED IN THE YARD?	NO . 						2
mc vcc nccruniif'i
[Ur Ifiu) MiinwKI Brj
D
Ni\WP31 iMMOA YKiFOXMSiOMSiH.B'A
PageS
emami
-------
SECTION B
HOUSE/BUILDING EXTERIOR
B18. IS GARBAGE STORED IN CONTAINERS	YES					1
IN THE YARD OR AROUND THE	NO					2
HOUSE/BUILDING??
PF NO, DESCRIBE WHAT/HOW:] 	LJ
B19. ARE THERE ANIMALS LIVING IN THE	YES				 . . 1
YARD OR AROUND THE	NO			2
HOUSE/BUILDING??
(IF YES, DESCRIBE:! 				
B20. DO YOU SEE ANIMAL FOOD AND/OR	YES				 . 1
DROPPINGS/FECES IN THE YARD OR	NO			2
AROUND THE HOUSE/BUILDING?
[IF YES, DESCRIBE:]
mwpsn£rABAnaFamsioas4i.Bi>A
Page 6
02/18/37
-------
SECTION C
HOUSE/BUILDING LOCATION 3c SURROUNDING AREA
CI. DISTANCE TO STREET:	FRONT OF HOUSE/BUILDING;	I I I I ft
BACK OF HOUSE/BUILDING:	MM FT
RIGHT SIDE OF HOUSEBUILDING: LJ	I	I ft
C2 TRAFFIC CONDITIONS AT TIME OF	LIGHT (LESS THAN 1 CAR/5 MIN) 	1
OBSERVATION:	MODERATE (l 4 cars/5 MIN) 		, . 2
HEAVY (5 CARS OR MORE/5 MIN)			3
[SPECIFY # OF CARS/5 MINUTES:]	I	I	I
[TIME OF OBSERVATION;]	I	I	I : L_i_J AM/PM
C3. FRONT ENTRANCE OF BUILDING:	AT STREET LEVEL					1
BELOW STREET LEVEL	2
ABOVE STREET LEVEL				 3
C4. ARE THERE STAIRS AT THE FRONT	YES					1
ENTRANCE?	NO						 ,1
C5. SURROUNDING AREA:	RESIDENTIAL			1
RECREATIONAL			2
COMMERCIAL 	3
INDUSTRIAL	4
WOODED					.5
MIXED (SPECIFY)			6
[SPECIFY:]
M'i WPS] SEP ADA YK\FORMS\OBS-Qi.EFA
Page?
02/1WS7
-------
SECTION C
HOUSE/BUILDING LOCATION * SURROUNDING AREA
C6. HOUSE/BUILDING SURROUNDING AREA:
YES	HQ
a.	CONSTRUCTION SITE		1	2
b.	DEMOLITION SITE		1	2
c.	VACANT/LITTER/DUMP SITE		1	2
d.	UNINHABITED BUILDINGS			1	2
e.	ADJACENT HOMES IN POOR CONDITION	1	2
f.	PUBLIC HOUSING PROJECT 			1	2
g.	FARM OR AGRICULTURAL AREA ...		1	2
h.	LAGOON OR DRAINAGE DITCH ....		1	2
L POWER LINES					1	2
j. MANUFACTURING FACILITIES	,1	2
k. INDUSTRIAL STORAGE FACILITIES		1	2
1. IRRIGATION DITCHES/CANALS 	.1	2
m. GARBAGE DUMPS 		1	2
n. STANDING WATER		1	2
o. RAILROAD/RAILROAD STATION 			1	2
p. SHOPPING CENTER(S) 				1	2
q. GAS STATION 						1	2
r. GREEN HOUSE/NURSERY/GARDEN		1	2
N:\Vm\EPMU YMFOKMSWBS-QI.EPA
PageS
03/1V97
-------
SECTION C	HOUSE/BUILDING LOCATION & SURROUNDING AREA
	LOCATION & SURROUNDINGS OF THE HOUSE		
SKETCH THE LOCATION AND SURROUNDINGS OF THE HOUSE/BUILDING, MEASURE THE APPROXIMATE
DIMENSIONS OF THE HOUSEBUILDING AND THE SIZE OF THE YARD (FRONT/BACK/SIDES).
Mi WPSUBMBA yK\FQRM$\OB$~Qt.EPA
Page 9
oa/im?
-------
The Environmental Study
House/Building Characteristics Observation Survey
(HOUSEHOLD)
1997
PARTICIPANT ID#: 11-111
-------
RECORD:
0 1
INTERVIEW INFORMATION
SUBRECORD:
PARTICIPANT ID #: I—I-
YERSION;

INTERVIEWER
ID#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
1 1 1
1 II! Ml 1 1
1 1 1 ¦ 1 1 1 AM'PM
1 1 1*1 1 1 ftM/PM
COMPLETE ........ 1
MM DD YY
INCOMPLETE	2



02
1
1 1 II 1 II 1 1


COMPLETE	1
1	1	1
MM DD YY


INCOMFLKtt ...... 2
03
i 1 1
1 1 II 1 II 1 1
llllll

COMPLETE	1

MM DD YY


INCOMPLETE 2
04
111
1 Ml Ml 1 1


COMPLETE	1
i *
MM DD YY


INCOMPLETE	2
REASONS FOR NONCOMPLETION;
01
02
03
04
N:\WP5 [*£PADA n&FOKMM>BS.Qi.EI>A
Page 1
os/aw?
-------
			SECTION A - HOUSE/BUILDING FLOOR PLAN
SKETCH THE INTERIOR OF THE HOUSE/BUILDING AND MARK AREAS SAMPLED WITH AN "X." USE A COMPASS TO
DETERMINE THE DIRECTIONS OF THE HOUSE AND MARK THE DIRECTIONS ON THIS SKETCH.
N:\WP51\EPADA YK\FORMS
-------
SECTION B • HOUSE/BUILDING EXTERIOR
B1. TYPE OF BUILDING STRUCTURE:	ONE-STORY HOUSE			01
ONE-STORY DUPLEX 			02
TWO-STORY HOUSE 						 03
TWO-STORY DUPLEX	04
TRAILER/MOBILE HOME 	05
APARTMENT	06
OTHER (SPECIFY)					07
REFUSED 			97
DK							 98
[SPECIFY OTHER:] 	LJ
B2. BUILDING MATERIALS - ROOF:	METAL 	1
WOOD SHINGLES OR PLYWOOD			....2
ASPHALT SHINGLES 			3
OTHER (SPECIFY)	4
[SPECIFY;] 	LJ
B3. BUILDING MATERIALS - SIDING:	VINYL SIDING ONLY					1
BRICK ONLY 					2
BEADED SIDING			3
BLOCK 	4
WOOD			5
BRICK AND VINYL/BEADED SIDING		6
BLOCK AND VINYL/BEADED SIDING	7
OTHER (SPECIFY)	8
[SPECIFY:] 		
B4. BUILDING FOUNDATION:	BLOCKS 					1
SLAB			2
CRAWL SPACE 	3
BASEMENT 	4
OTHER (SPECIFY)	5
[SPECIFY:] 	-					
B5. IS THERE A FRONT PORCH/ BALCONY?	YES 				1
NO	2
B6. IS THERE A DECK OR PORCH/	YES 		 1
BALCONY IN THE BACK OF THE	NO	2
HOUSE/BUILDING?
mWP}l\EeADArKSt'OXMS>0BS~Q2,£I>A
Page 3
osmm7
-------
SECTION B - HOUSEBUILDING EXTERIOR
B7. IS THERE A CONCRETE (OR PAVED)
DRIVEWAY?
YES
NO .
.. I
.2
[IFNO, SPECIFY:]
B8. IS THERE A CONCRETE (OR PAVED)
WALKWAY FROM THE DRIVEWAY TO
THE HOUSE/BUILDING?
YES
NO .
[IF NO, SPECIFY:]
B9. CONDITION OF EXTERIOR STRUCTURE:
YES	NO
a.	WELL MAINTAINED 				1	2
b,	PEELING PAINT		 .	1	2
C. SIDING IN DISREPAIR 		1	2
d.	PARTS OF SIDING OR ROOFING LYING IN YARD ...	1	2
e.	BROKEN WINDOWS				1	2
f.	BROKEN DOORS 		1	2
g.GENERALLY	DETERIORATED		1	2
B10. DESCRIBE THE AREA OUTSIDE IN	YARD > 50% COVERED WITH LAWN, TREES, ETC. ... 1
FRONT OF THE HOUSE/BUILDING	YARD > 50% BARE DIRT/MUD	2
(>=MORE THAN):	YARD > 50% PAVED		3
OTHER (SPECIFY)	4
[SPECIFY:]		
BIT. DESCRIBE THE AREA OUTSIDE IN THE	YARD > 50% COVERED WITH LAWN, TREES, ETC. ... 1
BACK OF THE HOUSE/BUILDING	YARD > 50% BARE DIRT/MUD	2
(>=MORE THAN):	YARD > 50% PAVED							3
OTHER (SPECIFY)	4
n
[SPECIFY:] 			J	I
B12. DESCRIBE THE AREA OUTSIDE ON THE	YARD > 50% COVERED WITH LAWN, TREES, ETC. ...1
LEFT SIDE (YOUR LEFT WHEN YOU	YARD > 50% BARE DIRT/MUD			2
FACE THE BUILDING) OF THE	YARD > 50% PAVED			3
HOUSE/BUILDING	OTHER (SPECIFY)			4
(>-MORE THAN):
f*.\WPSMPAMrXSFOftMS&BS~Q2.EPA
Page 4	oma/97
-------
SECTION B • HOUSE/BUILDING EXTERIOR
[SPECIFY;]
B13. DESCRIBE THE AREA OUTSIDE ON THE
RIGHT SIDE (YOUR RIGHT WHEN YOU
FACE THE BUILDING) OF THE
HOUSE/BUILDING
(>=MORE THAN);
YARD > 50% COVERED WITH LAWN, TREES, ETC. ... 1
YARD > 50% BARE DIRT/MUD				 2
YARD >50% PAVED			3
OTHER (SPECIFY)	.		 4
[SPECIFY:]
B14. IS THERE ANY ODOR OUTSIDE? IF YES, DESCRIBE IT.
YES
a.	FRONT OF HOUSE/BUILDING		 1
b.	BACK OF HOUSE/BUILDING 		 1
c.	LEFT SIDE OF HOUSE/BUILDING 	 1
d.	RIGHT SIDE OF HOUSEBUILDING	 1
NO
2
2
2
2
[DESCRIPTION:]
B15. IS THERE STANDING WATER OR ANY,
DISCHARGE INTO THE YARD OR
AROUND THE HOUSE/BUILDING?
(SUCH AS DISCOLORED WATER/ MUD,
ETC. FROM INDUSTRIAL, SEWAGE, OR
HOUSEHOLD WASTE)
YES
NO .
. 1
.2
[IF YES, CAN YOU SEE WHERE ITS COMING FROM;]
B16. IS THERE EVIDENCE THAT RUBBISH
BURNING WAS DONE ON THE
PROPERTY?
YES
NO .
[IF YES, DESCRIBE:]
B17. IS THERE EVIDENCE THAT GARBAGE
WAS DUMPED IN THE YARD?
YES
NO .
[IF YES, DESCRIBE:]
NAWfSISEPADA rWORMPiOBS-QZEPA
PageS
Osm/97
-------
SECTION B • HOUSE/BUILDING EXTERIOR
B18. IS GARBAGE STORED IN CONTAINERS	YES 			1
IN THE YARD OR AROUND THE	NO 			.....2
HOUSE/BUILDING??
[IF NO, DESCRIBE WHAT/HOW:] 	L_
B19. ARE THERE ANIMALS LIVING IN THE	YES 			1
YARD OR AROUND THE	NO 	2
HOUSE/BUILDING??
{IF YES, DESCRIBE:] 		
B20. DO YOU SEE ANIMAL FOOD AND/OR	YES 		 1
DROPPINGS/FECES IN THE YARD OR	NO 	,...2
AROUND THE HOUSE/BUILDING?
[IF YES, DESCRIBE] 		CD
K:\WPSl\EmDA rK>fORMXIBS-Q2.EPA
Page 6
osmt/sr
-------
SECTION C - HOUSE/BUILDING LOCATION & SURROUNDING AREA
CI. DISTANCE TO STREET:	FRONT OF HOUSEBUILDING:	Mil ft
BACK OF HOUSE/BUILDING:	LJ	I	I FT
[NOT APPLICABLE=996]	. . . .
LEFT SIDE OF HOUSE/BUILDING:	Mil ft
RIGHT SIDE OF HOUSE/BUILDING:	1 I I	I FT
C2. TRAFFIC CONDITIONS AT TIME OF	LIGHT (LESS THAN 1 Car/5 MIN) 		I
OBSERVATION:	MODERATE (14 CARS/5 MIN) 			2
HEAVY (5 CAES OR MORE/5 MIN) 	3
[SPECIFY # OF CARS/5 MINUTES:]	I	1	I
[TIME OF OBSERVATION;]	1	I	I : I	I	I AM/PM
C3. FRONT ENTRANCE OF BUILDING:	AT STREET LEVEL		 1
BELOW STREET LEVEL 	2
ABOVE STREET LEVEL	3
C4. ARE THERE STAIRS AT THE FRONT	YES 			1
ENTRANCE?	NO 	2
€5. SURROUNDING AREA:	RESIDENTIAL	1
RECREATIONAL					 2
COMMERCIAL					 3
INDUSTRIAL 	4
WOODED 		5
MIXED (SPECIFY)	6
[SPECIFY:]
WVfMMMM mrOHM^OBS.Q7.EPA
Page 7
OWW T
-------
SECTION C - HOUSE/BUILDING LOCATION & SURROUNDING AREA
C6. HOUSE/BUILDING SURROUNDING AREA;
YES
a.	CONSTRUCTION SITE		1
b.	DEMOLITION SITE		1
c.	VACANT/LITTER/DUMP SITE 		1
d.	UNINHABITED BUILDINGS 				1
e.	ADJACENT HOMES IN POOR CONDITION ...	1
f.	PUBLIC HOUSING PROJECT		1
g.	FARM OR AGRICULTURAL AREA		1
h.	LAGOON OR DRAINAGE DITCH		1
i.	POWER LINES			1
j. MANUFACTURING FACILITIES		1
k. INDUSTRIAL STORAGE FACILITIES		1
1. IRRIGATION DITCHES/CANALS 		1
m. GARBAGE DUMPS 				1
n, STANDING WATER 		1
o. RAILROAD/RAILROAD STATION			1
p. SHOPPING CENTER(S)		I
q. GAS STATION		1
r. GREENHOUSE/NURSERY/GARDEN		1
NO
2
2
2
2
2
2
2
2
' 2
2
2
2
2
2
2
2
2
2
N:\WP5I\EPADA ?KsF0RMS>QBS-Q2, EPA
Page 8
05/9W7
-------
SECTION C
HOUSE/BUILDING LOCATION & SURROUNDING AREA
LOCATION & SURROUNDINGS OF THE HOUSE
SKETCH THE LOCATION AND SURROUNDINGS OF THE HOUSE/BUILDING. MEASURE THE APPROXIMATE DIMENSIONS
OF THE HOUSE/BUILDING AND THE SIZE OF THE YARD (FRONT/BACK/SIDES).
nwkisepada n^ronMs^ts-Qixm
Page 9
ems/97
-------
The Environmental Study
Pre-Monitoring Questionnaire
(CHILD DAY CARE CENTER)
1997
PARTICIPANT ID#: U-l 1 I
-------
The Environmental Study
Pre-Monltorlng Questionnaire/Day Care Center
INTERVIEW INFORMATION
PARTICIPANT ID#: U-
RECORD:
0 1
SUBRECORD: I 0 I 0
VERSION: 0 1

INTERVIEWER
ID#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
1 1 1
			


COMPLETE 	1

MM DD YY


INCOMPLETE	2
02
1 1 I
		I


COMPLETE 	1
INCOMPLETE	2

MM DD YY


03
1 ! J
			


COMPLETE 	1
INCOMPLETE	2
1 	1
MM DD YY


04
1 1 1
1 1 It 1 II 1 1


COMPLETE 	1
1 1 1
MM DD YY


INCOMPLETE	2
REASONS FOR NONCOMPLETION:
01
02
03
04
RESPONDENT'S COOPERATION WAS:	VERY GOOD								1
GOOD 	.			.•	2
FAIR 						3
POOR			4
THE OVERALL QUALITY OF THIS	HIGH QUALITY					 1
INTERVIEW WAS:	GENERALLY RELIABLE 					2
QUESTIONABLE 			 (SPECIFY BELOW). . . 3
UNSATISFACTORY		 . (SPECIFY BELOW). . . 4
REASON(5) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
>31\£PADAmF{mMSiPM.QI.EPA
PAGE 1
02nwr
-------
The Environmental Study
Prt-Monitortng Questtamialre/Day Care Center
SECTION A
CHARACTERISTICS OF THE DAY CARE CENTER
In this interview I would like to ask you some general questions about the day care center.
Al. How many years has the day care center been	I I I

operated at this location?
YEARS
(DK = 98)
A2.
What is the maximum number of children that your
center can enroll?
Mil
# of Children
A3.
What is the total number of children currently
enrolled in your center?
MM
# of Children
A4.
How many classrooms do you have?
ASK AS THEN A6 FOR EACH AGE GROUP.
1 1 1
# of Classrooms

A5.
A6.

Would you please tell me the age group of the
children in each classroom?
How many classrooms do you have for the (AGE GROUP)?
Class-
room
Children's Age Group
Number of Classroom
01

1 1 1
02

1 1 1
03

1 I 1
04

1 1 1
05

I 1 1
06

1 1 1
07

1 1 1
08

1 1 1
09

1 1 1
10

1 1 1
mi WPADA mFOmiSWIlE-Ql.EPA
i
PAGE 2
QZ/imi
-------
The EnTironmental Study
Prt-MotUtgrinK Questionnaire/Day Care Ctnter
A7, What is the tuition and registration fee for enrolling IF THEY HAVE A CURRENT RATE SCHEDULE, ASK
a child in your center?	FOR A COPY AND YOU MAY COMPLETE THIS
flTn?CTTAM T ATT7D
IfAlJbKi
RECORD TUITION/FEE FOR EACH CATEGORY.	

Category
Tuition
Fee
01


-
02



03



04



05



06



07



A7a. Do you have any children in the center who are also	YES 	.	1
enrolled in the Head Start program?	NO					2
A8. How old is this (building/house)?	111!
YEARS
-------
The Environmental Study
Pre-Monltoring Questionnaire/Day Care Center
USE THE FLOOR PLAN/SKETCH AS A REFERENCE WHEN YOU ASK A10. THEN ASK A11-A13 FOR EACH ROOM.
A10,	All.	A12.	A13.
Would you tell me which rooms have carpet or
area rags? [SHOW FLOOR PLAN]
How old is the
carpet/area rags
in the (ROOM)?
In the past 3 months, was the
carpet/area rugs in tie
(ROOM) steam- or dry-
cleaned?
In the past week, was the
carpet/area rugs in the
(ROOM) vacuumed?
ROOM
Yes No
DK=98
Yes No DK
Yes No DK
m
1 2
L I 1 Years
1 1 1 Mnnfh^
1 2 8
1 2 8
2- III
1 2
L	i	1 Years
L_l	1 Months
1 2 8
1 2 8
3- III
1 2
L	1	1 Years
L_l	1 Months
1 2 8
1 2 8
4" III
1 2
L	I 1 Years
1 2 8
1 2 8
m
1 2
I 1 1
L	1	1 Months
1 2 8
1 2 8
6.


1 2
1 1 1
1 2 8
1 2 8

1
' ' ' Years
L 1 1 Months
7,

1 2
[ 1 1
1 2 8
12 8
1 1
1	 1 1 Years
1 1 1 Months
8.

1 2
[ | |
1 2 8
1 2 8
1 1
1 1 1 Months
9-

1 2

1 2 8
1 2 8
1 1
[ 1 1 MnnrlK
10.

1 2
1 1 1
1 2 8
1 2 8
1 1
l—l	1 Years
1 1 1 Months
11.

1 2
L	1	J Years
L	1	1 Months
1 2 8
1 2 8
| |

,,

1 2
1. 1 1 Years
I—1—1 Months
1 2 8
1 2 8
1 1
13.

1 2

1 2 8
1 2 8

inr i 1 Years
14.


1 2
i i i
1 2 8
12 8


L	1	1 Months
N:Vm>W£PADAYKSFOPMnPRErQLBPA
PAGE 4
wiam
-------
The Environmental Study
Prt-Monitodng^ueatlomiaire/Day Cart Center
The following questions are about the heating device you use to provide heat for the center.
[ASK A14 FOR ALL HEATING DEVJCE(S) USED, THEN ASK A15-A17 FOR EACH HEATING DEVICE.]
A14.	A15.	A16.	A17.
What kind of heating device do you use? Please
include anything you use on an occasional basis.
CIRCLE ALL THAT APPLY
On the average, about
how many days per
month did you use
(HEAT) in the past
winter?
When you used (HEAT)
in the past winter, on the
average about how many
hours per day did you
use it?
When was (HEAT) last
used?
(DK - 98 98 98)
HEAT
Yes
No
## Days/Month
## Hrs./Day
MM/DD/YY
a. CENTRAL ELECTRIC
1
2



b. CENTRAL GAS
1
2






c. KEROSENE SPACE HEATER
1
2






d. ELECTRIC SPACE HEATER
1
2






e. FIR]
EPLACE
1
2





f. WO<
3D STOVE
1
2



|
g. OTHER (SPECIFY)
1
2








h. OTI
IER (SPECIFY)
1
2



1

i. OTHER (SPECIFY)
1
2








j. OTHER (SPECIFY)
1
2








N.iWnHEPAJ3AmFOmS\Pim-Ql.EPA
PAGES
02/1M7
-------
The Environmental Study
Prt-MonltortnE QuestJonnaJre/Day Care Center
A18. Is the center located within a quarter mile of any	YES				 1
major freeway or industrial or incineration plants that	NO				 . 2
produce lots of smoke or a strange smell?	DK 				8
PF YES. SPECIFY:]
A19. What type of sewage system is used in the center?	MUNICIPAL ......... I	1
SEPTIC TANK	2
CESSPOOL 		3
OTHER	4
DK					8
[SPECIFY OTHER:]
A20. Have you ever seen sewage on the pound around the	YES	 1
center?	NO . 		(GOTOA23)	2
DK	(GO TO A23) ......... 8
A21. How many times did this happen last year?	I I 1 I Times/Year
A22. On the average about how many days each time did	1111 Days/Time
the sewage stay on the ground around the center?
A23. In general, would you say the traffic condition near	Light (less than l car/5 min)	I
the center during your normal business hours is...	Moderate, or (1-4CARS/5 MIN)	2
Heavy {5 CARS OR MORE/5 MIN) 		 3
A24. About what time during the day do you think there is
the most traffic near the center?
m\wpsi\EPAMmrosMSiPmQi.EPA
PAGES
02/1 a/a 7
-------
Hie Environmental Study
Prt-Monltorlng Qiusttonnairt/DaY Care Center
SECTION B
GENERAL INFORMATION ON CENTER STAFF AND THE CENTER
Bl. Does any of your staff, including yourself, smoke	YES		1
cigarettes, cigars, or a pipe on a regular basis, at work	NO	 too to B7)			 2
or at home?
B2. How many of your staff, including yourself, smote on	I I 1
a regular basis, at work or at home?
B3. Are they allowed to smote inside the center?	YES 			 . 1
NO 			 
-------
The Environmental Study
Pre-Monitoring Questionnalrt/Pay Care Center
B8.
B9.
What kind of cooking devices are used to cook
How often is (DEVICE) used to cook or heat the food?

or heat the food at the center?





DEVICE
# Times
Day
Week
Month
Don't Know

per




1
1 1 1
1
2
3
8
2
1 1 1
1
2
3
8
3
1 1 1
1
2
3
S
4
1 1 1
1
2
3
8
5
1 1 1
1
2
3
8
BIO. What are the sources of water for cooking
at the center?
CIRCLE ALL THAT APPLY
CITY 				 			1
WELL						2
BOTTLED			3
OTHER (SPECIFY) 								4
SPECIFY:
B11. What kind of containers does the center use to
serve snacks, breakfast and/or lunch to the
children? If forks and spoons are used, please
also tell me what they are made of. Are they,.. CIRCLE ALL THAT APPLY
1.
2.
3.
4.
5.
6.
7.
8.
9.
TYPE
CUPS
PLATES
FORKS/SPOONS
Disposable
YES = 1 NO=2
YES=L NO=2
YES=1 NO=2
Non-disposable
YES = 1 NO=2
YES=1 NO=2
YES=1 NO=2
Paper
YES-1 NO-2
YES=l NO-2
If
g
Plastic
YES=1 NO=2
YES = 1 NO=2
YES=1 NO=2
Styrofoam
YES = 1 NO=2
YES = 1 NO=2
YES-1 NO=2
Glass
c»
II
§
|i
YES=I NO—2
YES-1 NO=2
Stainless steel
N
II
o
z
¦r—l
YES=1 NO=2
S
O
II
M
Aluminum
YES=1 NO-2
YES=l NO=2
YES=1 NO=2
Any other kinds (SPECIFY)
YES=1 NO=2
YES=1 NO=2
YES=1 NO=2
specify:
NAWPSimP4DAnCFOUHS{PSE-Qt.EPA
PAGES
02/tm?
-------
The Environmental Study
Pre-Monltoring Questionnaire/Day Care Center
B12. What are the sources of drinking	CITY 								1
water for the center?	WELL 						2
BOTTLED		 					3
CIRCLE ALL THAT APPLY	OTHER (SPECIFY) 					4
SPECIFY:			
B12. Do you filter the drinking water at the	YES				 		"	 1
center?	NO 							 2
Now I have some questions about how the center is cleaned on a regular basis,
B13.
How often is the floor of the center ...

# Times per
Day Week Month Don't Know
a. sweep-cleaned?
1 1 1
12 3 8
b. vacuum-cleaned?
1 I 1
12 3 8
C. wet-mop-cleaned?
1 1 1
12 3 8
B14. Does the center have any pets?
YES				 1
NO	(GO TO B17)	2
B15. What kind of pets does the center have?
B16. Do you keep them inside or outside the center?
Inside 					 1
Outside 	2
Other 				 3
[SPECIFY OTHER;]
B17. Did anyone in your center change automobile oil in the
parking lot or driveway during the past year?
YES 				1
NO	(GO TO MO)	2
B13. How many times did this happen (changing automobile oil
in the parking lot or driveway) during the past year?
I Times
N:\WP511IMM mF0MiSirM-Ql.EPA
PAGE®
02/ia/97
-------
The Environmental Study

B19. How did they dispose of the automobile oil?		j j
B20, How does the center dispose of the garbage?
B2L What months of the year does the center usually close all of the exterior doors and windows because the heating or
air conditioning is running? [READ EACH MONTH;]
Yes C02
a.
January ..................
		 1
2
b.
February 						
1
2
c.
March	
1
2
d.
April	
	 1
2
e.
May 				
. . 			 1
2
f.
June			
		 1
2
g-
July . 				........
. . 			 1
2
h.
August			
			 1
2
i.
September 	
1
2
J".
October					
		 1
2
k.
November 	
			.... 1
2
1.
December	
1
2
N:WrSlWADAmrOMS\rRE-Ql.El'A
PAGE 10
02/18/37
-------
The Environmental Study
Pre-Monltoring Questionnaire/Day Care Center
Now I have a few questions about some commercial chemical products that may be used in your center.
[IF B22=YES, ASK B23-B26; IF B22=NO, ASK NEXT CHEMICAL.]
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION®, USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
a. Paint removers
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

l._l	1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
b. Water-based paints
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1	1	1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
c. Oil-based paints
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1	1	1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N:\WPS11EPADA YK\FORMS\PRE-Ql .EPA
PAGE 11
02/\8J31
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION®, USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
d. Stains/varnishes
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 TiniM ppr
1 = DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
e. Wood deck preservatives
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Timps ppr
1 = DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
f. Weed killers
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Timps ppr
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N: I WPS / \EPADA YK\FORMS\PRE-QI. EPA
PAGE 12
02/18/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION®, USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
g. Insecticides or pesticides (to
kill insects, rodents, etc.)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Timps p<«r
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
h. Fungicides (to kill fungal
growth and mold)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N.I WP51 \EPADA YK\FORMS\PRE-Ql.EPA
FAGE 13
02/18/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION(S), USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
i. Disinfectants (Lysol, etc.)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
j. Detergents/soaps
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 I I Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
k. Degreasers (for car/engine
repair)
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1	1	1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
AM WPS1 \EPADA YK\FORMS\PRE-Ql .EPA
PAGE 14
02/t 037
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
B22.	B23.	B24.	B25.	B26.
Has the center ever used
any...(CHEMICAL)? (This includes the
building where the center is located.)
Could you tell me the brand name(s) of the
(CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by
a commercial
contractor or by your
center staff? IF
CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
the center?)
RECORD THE LOCATION(S), USE THE
FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often did the
center use it?
When was the last time that
(CHEMICAL) was used and where
was it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
1. Kerosene
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Timoc por
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
m. Lighter fluid
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Timpc ppr
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
n. Charcoal
NAME:
1
2
NEXT
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Timoc per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
o. Natural gas
NAME:
1
2
CI
1.	commercial contractor
2.	center staff
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N:\WP511EPADA YK\FOXMS\FRE-Ql.EPA
PAGE 15
02/18/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Day Care Center
SECTION C
CHILD ACTIVITY INFORMATION
Now I am going to ask you some questions about the daily activities of the children In your center during the past month.
Since the air monitor is installed in the (4 • 5/OR THE ACTUAL ROOM) years old classroom, the following questions only
ntd	111
CI, Does the classroom have a daily activities schedule?
IF YES, ASK FOR A COPY OF THE SCHEDULE
FOR THE CLASSROOM THAT IS BEING
MONITORED.
C2. Did your staff (the teachers in that classroom) pretty
much follow the daily activities schedule?
YES 			 1
NO	 (GOTOC3)	2
YES
NO .
C3. Did you allow the children walking barefoot INSIDE
the center?
YES
NO .
C4. Did you allow the children walking barefoot OUTSIDE
the center?
YES
NO .
C5. About how many hours of nap time a day did the
children have at the center?
NO NAP TIME « 00
u
HOURS/DAY
[SKIP TO CB IF NO NAP TIME]
C6. Did the children sleep on the floor?
[IF NO, ASK WHERE AND THEN SKIP TO C8J
YES					1
NO ....... . (WHERE) ......... 2
WHERE:
C7. Was there a mattress, a pad, or a beach towel (to place
on the floor) for every child when they took a nap?
YES .........			1
NO		 . (EXPLAIN)	2
EXPLAIN:
mmiMPAMmroiiMS$piiE4i.EPA
PAGE 16
02/t8/37
-------
The Environmental Study
Pre-Monitnrlng Questionnaire/Day Care Center
C8. About how many hours a day did the children stay	I I I
outside the center (playing io the playground or out on	hours/day
a field trip, etc.)? Again, we are talking about the past
month,
C9, When the children played outside the center, would	YES	.	1
they frequently come in contact with the soil?	NO				 2
CIO. Where did the children usually play outside the center?
MARK ON THE SKETCH
€11. About how many hours a day did the children stay	I I i
inside the center?	hours/day
C12. How often were the hands of the children washed	Always 				 1
before eating snacks? Would you say...?	Most of die time 		2
Sometimes, or		 3
Rarely		 4
NA			5
DK			8
CI3. How often were the hands of the children washed	Always 	1
before eating breakfast and/or lunch? Would you	Most of the time 	2
say...?	Sometimes, or 					3
Rarely 			 4
NA			5
DK			8
C14. How often were the hands of the children washed after	Always 					1
playing outside? Would you say...?	Most of the time 		2
Sometimes, or . 				 3
Rarely		 4
NA	5
rsif	q
Am.	0
AVI W5V£PM>A HCWIWSlW&fl/
PAGE n
0&IM7
-------
The Environmental Study
Pre-Monltoring Oueationnalrt/Day Care Center
CONCLUDING STATEMENT
Thank you very much for your time, (Mr./Mrs./Ms.) (RESPONDENT'S LAST NAME). That concludes our interview for
today. We really appreciate your willingness to answer our questions and to participate in this important study. You've
been very helpful. As we told you earlier, the air monitors will run for about 48 hours. We may stop by tomorrow to check
the air monitors.
We'll see you again on (DAY	,DATE: / 1 around (TIME: 		AM / PM) to remove the air monitors.
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS
SOON AS POSSIBLE.
"3* DISCUSS THE FOOD SAMPLE COLLECTION INSTRUCTIONS WITH THE RESPONDENT.
K-\-milEPAIMril)FOfltiSWRE-ai.EPA
PAGE 18
SOftS/97
-------
The Environmental Study
Pre-Monitoring Questionnaire
(HOUSEHOLD)
1997
PARTICIPANT ID#: LJ-I 1 I
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
INTERVIEW INFORMATION
PARTICIPANT ID#: I	I-
RECORD:
SUBRECORD:
VERSION:

INTERVIEWER
ID#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY MASON)
01
1 1 1
	


COMPLETE	1
I 1
MM DD YY


INCOMPLETE	2
02
1 1 I
1 1 II 1 II II
1 I 1*1 1	1 AM / PM
1 1 1 • 1 I I AM / PW
COMPLETE	1

MM DD YY


INCOMPLETE	2
03
1 1 1
1 III 1 II 1 1
III- 1 1 I
1 1 II 1 1 AM/PM
COMPLETE	1
MM DD YY





04
1 I 1
1 Ml 1 II 1 1
1 1 I I 1 1 AM/PM
1 1 II 1 1 AM/PM
COMPLETE 			1
MM DD YY




liSCUMrLblb 		2
REASONS FOR NONCOMPLETION:
01
02
03
04
RESPONDENT'S COOPERATION WAS;
THE OVERALL QUALITY OF THIS
INTERVIEW WAS:
VERY GOOD 				1
GOOD 					2
FAIR 							3
POOR			4
HIGH QUALITY			 1
GENERALLY RELIABLE 	2
QUESTIONABLE	(SPECIFY BELOW)... 3
UNSATISFACTORY 	(SPECIFY BELOW)... 4
REASON(S) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
N:WP51\EPADA YfC&OR*fSsPRE-Q2. EPA
PAGE 1
05/QB/97
-------
The Environmental Study
Fre-Monitoring Questionnaire/Household
SECTION A
CHARACTERISTICS OF THE HOUSE
In this interview we will be discussing a number of topics including your home, your family, your child's daily activities, and any
commercial chemical products used in and around your home. I'd like to begin by asking some questions about the house.
Al. How old is the house?	I I I I
YEARS
(I>K ¦ 'MR)
A2, Do you own or rent this house? (IF RENT, ASK NAME
AND PHONE NUMBER OF OWNER OR LANDLORD-JUST IN
CASE WE NEED TO CHECK THE AGE OF THE HOUSE AND
THE CARPET)
Own						 1
Rent 						.. 2
Other					 3
DK					8
[SPECIFY OTHER;]
NAME OF OWNER/LANDLORD:
TELEPHONE NUMBER:
N:\WPSMPADA rKSFORMS^KE-QlEPA
PAGE 2
MafUCmf
-------
The Environmental Study
Pre-Mawilnring Questionnaire/Household
[USE HOUSE FLOOR PLAN TO IDENTIFY EACH ROOM. ASK A3 FOR ALL ROOMS. THEN ASK A4-A7 FOR EACH ROOM.]
A3.	A4.	A5.	A6.	A7.
What rooms do you have in the
house?
Is there carpet in
the (ROOM)?
How old is the
carpet in the
(ROOM)?
In the past 3 months, was the
carpet in the (ROOM) steam-
or dry-cleaned?
In the past week, was the
carpet in the (ROOM)
vacuumed?
ROOM
Yes No
DK=98
Yes No DK
Yes No DK


1 2
1	1	1 Years
1	1	! Months
12 8
1 2 8
1.




1 2
1 1 1 Yffflrc
1 1 1 Mnnth^
1 2 8
1 2 8
2.


3.


1 2
l l l
I 2 8
1 2 8


1 1 1 Mnntfiij


1 2
1 1 1
1 1 1 Mrailfit;
1 2 8
1 2 8
4.




1 2
1 1 I Vms
I 1 1 Mrmrtlc
1 2 8
1 2 8
5,


,


1 2
1 1 1
1 2 8
1 2 8


I I 1 Mnnth«
7-

I 2
1 1 1 Ypnrc
1	1	1 Months
1 2 8
1 2 8

8,

1 2
1	1	1 Years
1	1	1 Months
1 2 8
1 2 8
1 1


1 2
1 1 1 Vmi-«
1 1 1 Mnnthc
1 2 8
1 2 8
9,


10.


1 2
1 1 1Y«n
1	1	1 Months
1 2 8
1 2 8
11.


1 2
1 1 1 Yrarrs
1 1 1 Mnnrtic
1 2 8
1 2 8
12.


1 2
1	1	1 Years
I 1 1 Mntirhc
1 2 8
1 2 8
13.


1 2
1 1 1 Y,.„rc
I I 1 Months
1 2 8
1 2 8
14.


1 2
1	1	1 Years
1	1	1 Months
1 2 8
1 2 8
N:\WP5J\EPADAYKSFOmSWEE-e2.EPA
PAGE 3
Mafismtf
-------
The_Environmental_Stud£
Pre-Monitoring Questionnaire/Household
The following questions are about the heating device you use to provide heat for your home.
[ASK A8 FOR ALL HEATING DEVICE(S) USED, THEN ASK A9-A11 FOR EACH HEATING DEVICE.]
A8.	A9.	A10,	All.
What kind of heating device do you use? Please
On the average, about
When you used (HEAT)
When was (HEAT) last
include anything you use on an occasional basis.
how many days per
in the past winter, on the
used?





month did you use
average about how many

CIRCLE ALL THAT APPLY


(HEAT) in the past
hours per day did you use
(DK = 98 9898)





winter?
it?

HEAT
Yes
No
## Days/Month
## HrsVDay
MM/DD/YY
a. CENTRAL ELECTRIC
1
2






b. CENTRAL GAS
1
2






c. KEROSENE SPACE HEATER
1
2






d. ELECTRIC SPACE HEATER
1
2






e. FIREPLACE
1
2






f. WOOD STOVE
1
2






g. OTHER (SPECIFY)
1
2









h. OTHER (SPECIFY)
1
2









i. OTHER (SPECIFY)
1
2









j. OTHER (SPECIFY)
1
2









N:\WP5MPADAriAFORMWRE-e2.EPA
PAGE 4
Mafepmr
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
A12. Is your house located within a quarter mile of any	YES 	 1 1 *
major freeway or industrial or incineration plants that	NO 			 2
produce lots of smoke or a strange smell?	DK	 8
[IF YES, SPECIFY:] 			 1 '
A13. What type of sewage system is used in your home?	MUNICIPAL	 1 ( 1
SEPTIC TANK 	 2
CESSPOOL 	 3
OTHER 			4
DK		8
[SPECIFY OTHER;] 	—	 1 1
A14. Have you ever seen sewage on the ground around	YES 							 1 ( 1
your house?	NO	(GOTOA17)	 2
DK		 . (GO TO A17) 		 8
A15.	How many times did this happen last year?	I I I I Times/Year	1 *
A16. On the average about how many days each time did	1 I I I Days/Time
the sewage stay on the ground around your house?
A17. In general, would you say the traffic condition near	Light				 1
your house is...	Moderate, or 			 2
Heavy					 3
A18.	Ahout what time during the day do you think there is	—— (
the most traffic near your house?		l_J_J
mWPSISEPADA ftCsFORM$J>ll£-Q2.£PA
PAGE 5
topmm?
-------
i nc Environmental study
Pre-Monitoring Questionnaire
SECTION B
HOUSEHOLD INFORMATION
Next I would like to ask you some questions about the members of your household. [ASK B1 FIRST. IF B2=YES, ASK B3 AND B4]
Bl.	B2.	B3.	B4.
Would you tell me the first name of everyone living in this household, their
ages, and their relationships to you? Let's start with you.
[CLARIFY SEX IF NECESSARY]
Does anyone in the
household regularly
smoke cigarettes,
dears, or a pipe in the
house? Would vou
tell me who they are?
[NO —> B5]
On average, what is the total number of
cigarettes, cigars, or pipesful of tobacco per day
that (PEOPLE) smoke in the house?
Where do/does
(PEOPLE) usually
smoke in the house?
CHECK THE ROOM
IN A3.
PEOPLE/NAME
AGE
RELATIONSHIP
YES NO
CIGS/ DAY CIGARS/DAY PIPES/ DAY
WHERE SMOKE
PERSON #1
1 1 1
SELF 1 1 1
1 2
III III III
~


PERSON #2
1 1 1
m
1 2
		 Ml
~


PERSON #3
1 1 1
m
1 2
III III III
~


PERSON #4
1 1 1
m
1 2
III III III
~


PERSON #5
1 1 1
m
1 2
III III III
~


PERSON #6
1 1 1
m
1 2
III III III
~


PERSON #7

m
1 2
III III III
~


PERSON #8
1 1 1
m
1 2
III III III
~


PERSON #9
1 1 1
m
1 2
III III III
~


PERSON #10
1 1 1

1 2
III III III
~


PAGE 6
05/08/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
The next few questions are about the employment of your household members.
B5. Are you currently employed?
YES 	 1
NO		 (GO TO B9)	 2
B6. Who do you work for? [IF SELF-EMPLOYED, GO TO B 8]
B7. What does the (company/person) do?
B8. What kind of work do you do?
B9, Is anyone else living in the household employed?
YES 	 1
NO			(GO TO B17)	 2
[IF YES, SPECIFY WHO:)
BIO. Who does (he/she) work for? [IF SELF-EMPLOYED, GO TO
B12]
B11, What does the (company/person) do ?
B12. What kind of work does (he/she) do?
B13. Is anyone else living in the household employed?
YES 			 1
NO 	(GOTOB17)	 2
[EF YES, SPECIFY WHO:}
N:\WP5 IXEPADA YfKFORMSSPRE- Q2. EPA
PAGE 7
05/08/97
-------
The Environmental Study
Prc-Monitoring Questionnaire/Household
B14, Who does (he/she) work for? [IF SELF-EMPLOYED, GO TO
B16]
B15. What does the (company/person) do?
B16. What kind of work does (he/she) do?
Now I am going to ask you some questions about the daily activities of your household.
B17.	BIS,
What do you use to cook or heat food?
(COOK)
How often do you use (COOK)?
# Times
Per
Day Week Month Don't Know
1
1 1 I
1 2 3 8
2
1 I I
12 3 8
3
1 1 1
12 3 8
4
1 I 1
12 3 8
5
1 1 I
12 3 8
6
1 1 1
12 3 8
( )
( )
( )
B19,	B20.
How often does someone...
# Times
Per
Dav Week Month Never DK
1. Vacuum the house?
1 1 1
1 2 3 4 8
2. Wet-mop the floor?
1 1 1
1 2 3 4 8
3, Sweep the floor and entrance?
1 ! 1
1 2 3 4 8
NAWPSfSEPADA r&\FORMSiPRE-(i2.Em
PAGES
05KW97
-------
TliejRi^
Pre-Monitoring Questionnaire/Household
B21, What are the sources of drinking water for your home?	CITY 			1
WELL						 2
CIRCLE ALL THAT APPLY	BOTTLED		 3
OTHER (SPECIFY).			4
SPECIFY:
B22. Do you filter your drinking water?	YES 	.	,. 1
NO 	2
DK 			.....8
B23. What are the sources of water for cooking?	CITY 	1
WELL				 2
CIRCLE ALL THAT APPLY	BOTTLED					3
OTHER (SPECIFY)			.4
SPECIFY:
B24. What are the sources of water for bathing?	CITY 			1
WELL				 2
CIRCLE ALL THAT APPLY	BOTTLED 					 3
OTHER (SPECIFY)	4
SPECIFY:
B25. Do you have any pets?	YES 			1
NO	(GOTOB2B)			2
B26. What kind of pets do you have?
B27. Do you keep your pets inside the house or outside the house?	Inside 	1
Outside				 2
Other 									3
[SPECIFY OTHER:]
B28. Does anyone living in this household usually take off shoes at the	YES 				 1
door before getting into the house?	NO	(GO TO B30) 			 2
B29. How many people in your household do that?	# PEOPLE TAKE SHOES OFF:	
mwrnSEPADAnMORMWRE-QZEPA	PAGES	05/09/37
-------
The Environmental Study
l'rf-Monitorinii Questionnaire/Household
B30. Do you usually ask your visitors to take off their shoes at the door	YES
before they get into the house?	NO .
, 1
,2
B31, Does anyone living in this household often walk barefoot outside
the house?
YES 			
NO	(GO TO B33)
B32. How many people in your household do that?
# PEOPLE WALK BAREFOOT OUTSIDER
B33. Does anyone in your household frequently work or play in the yard YES
that would involve contact with soil?	NO .
... 1
...2
[F YES. WHO:]
B34. Does anyone in your household change automobile oil in the
driveway or garage (or near your house)?
YES 	1
NO	(GOTOB37)	2
[IF YES, WHO;]
B35. How often (does/do) (PEOPLE IN B33) change oil in the driveway	I I I Times Per
or garage?
MONTH	1
YEAR	2
DK 			8
B36. How (do/does) (they/you/he/she) dispose of the automobile oil?
B37. How do you dispose of your garbage?
PICKED UP BY THE CITY			1
PICKED UP BY A COMMERCIAL
CONTRACTOR			2
OTHER (SPECIFY)	3
SPECIFY:
N:\WP51SEPADA YK\FQRMSJ>RE~Q2. BP A
PAGE 10
m/mm
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
B37. What months of the year do you usually close all of the exterior doors and windows because of heating or air conditioning is
running? [READ EACH MONTH:]


Yes
No
NOTE
a.
January			
1
2

b.
February	
1
2

e.
March	
1
2

d.
April	
1
2

e.
May 			
1
2

f.
June 			
1
2

%•
July	
1
2

h.
August 	
1
2

i.
September		
1
2

j-
October			
1
2

k.
November			
1
2

'
December			
1
2

N:\WPSI\EPADA mFORMMRE-Q2.EPA
PAGE 11
oema/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
SECTION €
CHILD ACTIVITY INFORMATION
Now I am going to ask you some questions about (CHILD'S NA.\lE)'s dally activities during the past 6 months. Please take
a moment to think about what (CHILD'S NAME) did inside the house and outside the house during that period of time.
CI. On the average, about how many hours a day,
including nap time, did (CHILD'S NAME) sleep?
I Hours I	1	I Minutes
PER DAY
( )
C2. On the average, about how many hours a day did
(he/she) stay outside the house (excluding hours
at the day care center)? (PROMPT: HOURS ON
WEEKDAYS AND HOURS ON WEEKENDS)
Hours I
1—I Minutes
PER DAY
( )
C3. Where did (he/she) usually play outside the house?
< )
C4. When (CHILD'S NAME) was outside the house,
how often did (he/she) walk barefoot? Would you
say...
Most of the time		1
Sometimes, or	2
Rarely or almost never	3
DK	,	8
l )
C5. How often did (CHILD'S NAME) eat or drink
when (he/she) was playing outside the house?
C6, When (CHILD'S NAME) was outside the house,
how often did (he/she) play with sand or dirt?
C7. Where did (he/she) usually play inside the house?
Most of the time	 1	( }
Sometimes, or 				2
Rarely or almost never			 3
DK			8
Most of the time				1	1 J
Sometimes, or	2
Rarely or almost never	3
DK 				8
( )
C8. When (CHILD'S NAME) was inside the house,
how often did (he/she) walk barefoot?
Most of the time	 1
Sometimes, or	2
Rarely or almost never 				 3
DK		 8
I }
NKWPSlSEPADAiKSFOm&PR&Qim
PAGE 12
os/om7
-------
The Environmental Study
Pre-MomioiingQuestionnaf re/Household
C9. When (CHILD'S NAME) was inside the house,	Most of the time	 1
how often did (he/she) sit or play on the floor?	Sometimes, or	2
Rarely or almost never	3
DK			8
CIO. How often did (he/she) sleep or take a nap on the
floor?
Most of the time		1
Sometimes, or	2
Rarely or almost never			3
DK 		8
Cl 1. Have you ever seen (him/her) eat dirt or sand?
C12. Have you ever seen (him/her) eat snow?
YES 		 1	1 1
NO 		2
DK		 8
YES 		 1	1 >
NO 	2
DK					8
C13. Did (CHILD'S NAME) use a pacifier in the past	YES 			 1
six months?	NO 		2
DK			8
C14.
C15.
In the past six months, did (he/she) suck or chew (his/her)...?
How often did (he/she) suck or chew (his/her) (SUCK IN
C14)? Would you say...?
SUCK
Yes
No
Don't Know
Most of the
Time
Sometimes
Rarely/
Almost Never
DK
a. Thumb/fingers
1
2
8
1
2
3
8
b. Toe
1
2
8
1
2
3
8
C16. How often did you cut (his/her) finger nails and
toe nails?
C17. How often did (CHILD'S NAME) put toys in
(his/her) mouth? Would you say...?
1	1	I Times per
WEEK 			1
MONTH		2
DK		8
Most of the time		1
Sometimes, or		2
Rarely or almost never 				3
DK					8
( )
( }
N:WPSH\EPADAmf0RM£MtE-QZEPA
PAGE 13
05/09/97
-------
The Environmental Study
Fre-Monitoring Questionnaire/Household
CI 8. Did (he/she) put any things other than toys or	YES 			 1
foods in (his/her) mouth?	NO	(go to C20) 			 2
DK					 8
C19. What did (he/she) put in (his/her) mouth?
C20. How often were (CHILD'S NAME)'s hands	Most of the time				1
washed before eating meals? Would you say...?	Sometimes, or 			2
Rarely or almost never 			3
DK				8
C2L How often were (his/her) hands washed before	Most of the time	.		1	( 1
eating snacks? Would you say...?	Sometimes, or		2
Rarely or almost never	3
DK		8
C22. How often were (his/her) hands washed after	Most of the time		1	( }
playing outside the house? Would you say...?	Sometimes, or			2
Rarely or almost never			3
DK		8
C23. How often were (his/her) hands washed before	Most of the time		1
going to bed? Would you say...?	Sometimes, or		2
Rarely or almost never				3
DK		8
N:\WPS1\EPADA rWOXMSV>RE-a2.B>A
PAGE 14
amm?
-------
The Knvirunini'iital Study
Pre-Monitoring Questionnaire/Household
SECTION D
HOUSEHOLD CHEMICAL USE
Now I have a few questions about some commercial chemical products that may be used in your home.
[IF D1=YES, ASK D2-D5; IF Dl=NO, ASK NEXT CHEMICAL.]
Dl.	D2.	D3.	D4.	D5.
Was any of the following chemicals ever
used in or around your home?
IF YES, ASK: Could you tell me the brand
name(s) of the (CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by a
commercial contractor or
by a household member?
IF CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
your home?)
RECORD THE LOCATION(S), USE
THE FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often was it used?
When was the last time that
(CHEMICAL) was used and where was
it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
a. Paint removers
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1 1	1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
b. Water-based paints
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1 1 1 Timnc pt>r
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
c. Oil-based paints
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

L. L—1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N:\WP5I\EHADA YK^tORMS\PRb-Q2. EfA
PAGE 15
05/08/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
Dl.	D2.	D3.	D4.	D5.
Was any of the following chemicals ever
Was it (done/used) by a
Where was the(CHEMICAL) used?
How often was it used?
When was the last time that
used in or around your home?


commercial contractor or
(Was it used inside and/or outside

(CHEMICAL) was used and where was
IF YES, ASK: Could you tell me the brand
by a household member?
your home?)

it used?
name(s) of the (CHEMICAL) that was used?
IF CONTRACTOR, GET
RECORD THE LOCATION®, USE





NAME AND TEL#.
THE FLOOR PLAN OR SKETCH AS A

(DK = 98 98 98)
CIRCLE ALL THAT APPLY



REFERENCE.

CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
d. Stains/varnishes
1
2
1. commercial contractor


DATE:
NAME:


2. Household member

1	1	1 Times per



NEXT
NAME:

WHERE:





1=DAY 2=WEEK






3=MONTH 4=YEAR




Tel:



e. Wood deck preservatives
1
2
1. commercial contractor


DATE:
NAME:


2. Household member

1 1 1 Timpc ppr



NEXT
NAME:

WHERE:





1=DAY 2=WEEK






3=MONTH 4=YEAR




Tel:




1
2
1. commercial contractor


DATE:



2. Household member

III Times per

f. Weed killers

NEXT
NAME:

WHERE:
NAME:




1=DAY 2=WEEK






3=MONTH 4=YEAR




Tel:



N:\WP51\EPADAYK\FORMMRE-Q2.EPA
PAGE 16
05/08/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
Dl.	D2.	D3.	D4.	D5.
Was any of the following chemicals ever
Was it (done/used) by a
Where was the(CHEMICAL) used?
How often was it used?
When was the last time that
used in or around your home?


commercial contractor or
(Was it used inside and/or outside

(CHEMICAL) was used and where was
IF YES, ASK: Could you tell me the brand
by a household member?
your home?)

it used?
name(s) of the (CHEMICAL) that was used?
IF CONTRACTOR, GET
RECORD THE LOCATION(S), USE





NAME AND TEL#.
THE FLOOR PLAN OR SKETCH AS A

(DK = 98 98 98)
CIRCLE ALL THAT APPLY



REFERENCE.

CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY

1
2
1. commercial contractor


DATE:
g. Insecticides or pesticides (to


2. Household member

1	1	1 Times per

kill insects, rodents, etc.)

NEXT
NAME:

WHERE:
NAME:




1=DAY 2=WEEK






3=MONTH 4=YEAR




Tel:




1
2
1. commercial contractor


DATE:
h. Fungicides (to kill fungal


2. Household member

I I 1 Times per

growth and mold)

NEXT
NAME:


WHERE:
NAME:




1=DAY 2=WEEK






3=MONTH 4=YEAR




Tel:



N:\WP51\EPADA YK\FORMS\PRE-Q2. EPA
PAGE 17
05/06/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
Dl.	D2.	D3.	D4.	D5.
Was any of the following chemicals ever
used in or around your home?
IF YES, ASK: Could you tell me the brand
name(s) of the (CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by a
commercial contractor or
by a household member?
IF CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
your home?)
RECORD THE LOCATION(S), USE
THE FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often was it used?
When was the last time that
(CHEMICAL) was used and where was
it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MMADD/YY
i. Disinfectants (Lysol, etc.)
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1	1	1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
j. Detergents/soaps
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1 1 1 Timpc per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
k. Degreasers (for car/engine
repair)
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1	1	1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
N:\WPS1\EPADA YK\FORMS\PRE~ Q2.EPA
PAGE 18
05/08/97
-------
The Environmental Study
Pre-Monitoring Questionnaire/Household
Dl.	D2.	D3.	D4.	D5.
Was any of the following chemicals ever
used in or around your home?
IF YES, ASK: Could you tell me the brand
name(s) of the (CHEMICAL) that was used?
CIRCLE ALL THAT APPLY
Was it (done/used) by a
commercial contractor or
by a household member?
IF CONTRACTOR, GET
NAME AND TEL#.
Where was the(CHEMICAL) used?
(Was it used inside and/or outside
your home?)
RECORD THE LOCATION(S), USE
THE FLOOR PLAN OR SKETCH AS A
REFERENCE.
How often was it used?
When was the last time that
(CHEMICAL) was used and where was
it used?
(DK = 98 98 98)
CHEMICAL
Yes
No
WHO
WHERE
HOW OFTEN
MM/DD/YY
1. Kerosene
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1 1 1 Timps pf»r
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
m. Lighter fluid
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1 1 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
n. Charcoal
NAME:
1
2
NEXT
1.	commercial contractor
2.	Household member
NAME:
Tel:

1 1 1 Timps ppr
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
o. Natural gas
NAME:
1
2
CI
1.	commercial contractor
2.	Household member
NAME:
Tel:

I I 1 Times per
1=DAY 2=WEEK
3=MONTH 4=YEAR
DATE:
WHERE:
D6. Where do you store the above chemicals?	LOCATION(S):
N:\WP51\EPADA YK\FORMS\PRE- Q2.EPA
PAGE 19
05/08/97
-------
The Environmental Study
Pre-Moniloring Questionnaire/Household
SECTION E
COOKING PRACTICE
El.
Now I would like to ask you how often in the past year you used any of the following methods to cook or heat
food.
METHOD
# times
(00=never in past year)
day week month year DK
a. Grill
1 1 1
1 2 3 4 8
b. Broil
i 1 1
1 2 3 4 8
c. Roast
1 1 1
1 2 3 4 8
d. Deep-fry
1 1 1
1 2 3 4 8
e. Fry
1 I I
1 2 3 4 8
f. Stir-fry (or saute)
1 I I
1 2 3 4 8
g. Microwave
1 1 i
1 2 3 4 8
h. Steam
1 1 1
1 2 3 4 8
i. Bake
1 1 I
1 2 3 4-g
j. Stew (slow cooking, or simmer)
I 1 1
1 2 3 4 8
k. Boil
I I [
1 2 3 4 8
1. Other 1 1 1
luppriFV riTHPp •]
1 2 3 4 8
NAWP51^PADAYXSFORMSRE.Q2.EPA
PAGE 20
05/68/97
-------
The Environmental Study
Pre-Mcnilorwig Questionnaireftloiisehold
E2. What kinds of fat did you usually use in cooking (to deep-fry, fry, or stir-fry) in the past year? Did you
use...?
FAT
Yes
No
Don't Know

a. Vegetable oil ....							
1
2
8
f
b. Corn oil			
1
2
8
{
c. Peanut oil 			
1
2
8

d. Butter 	
1
2
8
i
e. Margarine 	
1
2
8
!
f. Bacon fat			
1
2
8
(
g. Lard/fatback 		
1
2
8
(
h Other			
1
2
8
(
[SPECIFY OTHER:]






(
mWPSJSEPAMriOfOliMSWRE-QLEPA
PAGE 21
0308/97
-------
The Environmental Study	Fre-Monltoring Questionnaire/Household
CONCLUDING STATEMENT
Thank you very much for your time, (Mr./Mrs./Ms.) (RESPONDENT'S LAST NAME). That concludes our interview for
today. We really appreciate your willingness to answer our questions and to participate in this important study. You've been
very helpful. We'll see you tomorrow around (TIME).
TIME:
DATE:
TIME;
AM/PM
COMMENTS?
( )
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS SOON AS POSSIBLE.
NAWPSISEPADAYfN'VmStPME-QZ.EPA
PAGE 22
05/03/97
-------
The Environmental Study
Post-Monitoring Questionnaire
(DAY CARE CENTER - PHASE ID
1997
PARTICIPANT ID#: li.M I
-------
INTERVIEW INFORMATION
PARTICIPANT ID#: LJ-L
RECORD:
0 1
SUBRECORD: I 0 I 0
VERSION:
0 1
INTERVIEWER
ID#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
MM DD YY
AM/PM
J ; L
AM/PM
COMPLETE ..
INCOMPLETE
02
i i ii i ii i i
MM DD YY
J : I	1	I
AM/PM
AM/PM
COMPLETE ..
INCOMPLETE
03
MM' DD YY
l_U:L_U
AM/PM
AM/PM
COMPLETE .,
INCOMPLETE
04
ILL
MM DD YY .
L_U:L_U
AM/PM
AM/PM
COMPLETE ,.
INCOMPLETE
01
02
REASONS FOR NONCOMPLETION:
03
04
RESPONDENT'S COOPERATION WAS:
VERY GOOD 	 1
GOOD 			2
FAIR		 3
POOR	4
THE OVERALL QUALITY OF THIS
INTERVIEW WAS:
HIGH QUALITY						 I
GENERALLY RELIABLE			 2
QUESTIONABLE	(SPECIFY BELOW)... 3
UNSATISFACTORY 			(SPECIFY BELOW)... 4
REASON(S) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
05/0S/9T
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center - II
[INSTRUCTIONS: ASK THE QUESTIONS FOR EACH GROUP OF THE CHILDREN (GROUP A OR B). RECORD ANY DIFFERENT
ACTIVITIES OF THE INDIVIDUAL CHILD IN THE NOTE BOOK. AFTER THE INTERVIEW, USE THIS COMPLETED QUESTIONNAIRE
TO COMPLETE A POST-MONITORING QUESTIONNAIRE FOR EACH CHILD IN THE GROUP.]
I would like to ask you some questions about the daily activities of (CHILD'S NAME) at the day care center during the 48-
hour air monitoring period, that is from		 to	. First,
I. Did (CHILD'S NAME) do anything during the 48-hour period that brought (him/her) near any of the following materials,
places, or activities?
MATERIALS, PLACES, OR ACTIVITIES
YES
NO
IF YES, WHERE
a. freshly applied paint			
1
2

b. food being fried, grilled, or barbecued	
1
2

c. burning of rubbish, garbage, or yard waste 	
1
2

d. other open flames, including barbecue flames, fires ......
I
2

e. glues or other adhesives				
1
2

f. solvents, fumes, or odorous chemicals	
1
2

g. floor wax, furniture wax, or shoe polish	
1
2

h. gasoline- or diesel-powered equipment other than
automobiles, including lawn mowers				
1
2

i. household cleaning agents, such as scouring powders or
ammonia				
1
2

j. excessive dust in the air	
I
2

k. stain or spot removers 		
1
2

1. gas station or auto repair shop 		
1
2

m. around where someone was pumping gasoline	
1
2

n. around a gas range or oven when it was used 		
1
2

o. around a microwave oven when it was used 		
1
2

p. freshly applied insecticides or pesticides (used to kill
insects, rodents, etc.) 		
1
2

q. freshly applied herbicides such as weed killers (in farm
fields or gardens)			
1
2

r. roofing tar or road tar	
1
2

s. around someone who was changing automobile oil	
1
2

t. Fungicides (to kill fungal growth and mold) 	
1
2

u. Disinfectants (Lysol, etc.) 			
1
2

N:\WPSr£PADArKSF0XM$J>O$T-Q3,£PA
PAGE 1
omm?
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center - II
MATERIALS, PLACES, OR ACTIVITIES
v. Delergents/soaps 	
YES
1
NO
2
IF YES, WHERE
w. Dcgreasers (for car/engine repair) 	
1
2

x. Kerosene 	
!
2

y. Lighter fluid	
1
2

z. Charcoal	
1
2

aa. Natural gas	
1
2

[CONFIRM THE FOLLOW INFORMATION WITH THE DAY CARE DIRECTOR] •*
2.	3.
Was any of the following (heating system/heater) used in this
classroom during the 48-hour period? IF YES, ASK #3,
About how many hours a day during the 48-hour
period was it used?
HEATING SYSTEM/HEATERS
YES
NO
HOURS/DAY
a. Central electric heat
1
2




b. Central gas heat
1
2




c. Kerosene space heater
1
2




d. Electric space heater
1
2




e. Fireplace
1
2




f. Wood stove
1
2




g. OTHER (SPECIFY)
1
2






h. OTHER (SPECIFY)
1
2






i. OTHER (SPECIFY)
1
2






N:\WKJ\EPADA YXSFOMSWOSr-QJ.EPA
PAGE 2
0S/WS7
-------
The Environmental Sludv
Post-Monitoring Questionnaire/Day Care Center ¦ II
4.	Did anyone smoke cigarettes, cigars, or a pipe inside the	YES 			1
classroom during the 48-hour period?	NO		 (GO TO 6) 	2
5.	About how many cigarettes, cigars, or pipesful of tobacco	I I 1	I I 1	I 1 I
were smoked inside the classroom during the 48-hour	CIGARETTES CIGARS	PIPES
period?
6. Did someone vacuum the floor inside the classroom	YES 	.1
during the 48-hour period?	NO 			2
Did you or someone apply any of the following chemicals in or [CONFIRM THE FOLLOW INFORMATION WITH THE
around the day care center during the 48-hour period?	DAY CARE DIRECTOR] v

YES
NO
IF YES, WHERE AND WHEN?
1. insecticides or
1
2
WHERE:
pesticides (used to



kill insects,



rodents, etc.);






WHEN:
2. herbicides such as
1
2
WHERE;
weed killers (in



farm fields or



gardens); or






WHEN:
3, Fungicides (to kill
1
2
WHERE:
fungal growth and



mold).






WHEN:
N:\WPSl\EPADA YJCsfORM^JP QST- QJ, EPA
PAGE 3
os/om?
-------
The Environmental Study
Post-Monitoring Questionnaire/Day Care Center - H
[INTERVIEWER: ONLY ASK THIS QUESTION ONCE FOR EACH DAY CARE TEACHER ON THURSDAY.]
Now I would like to ask you some questions about your opinions on this study.
8. Do you feel that any of the following activities was too much of a burden, too confusing, or caused too much
inconvenience to you and your family? [READ LIST:]
YES NO	IF YES, WHY?
a.	Collecting urine samples 		1	2
b.	Collecting food samples		1	2
c.	Collecting hand-wipe samples		1	2
d.	Recording Child Activity Diary		1	2
e.	Air sampling inside the day care center		1	2
f.	Air sampling outside the day care center		I	2
g.	Doing the interviews with us 		1	2
h.	Dust sampling inside the day care center		1	2
9, Do you have any comments or suggestions about the
YES 		
	'	 1
study?
NO	
		 2
CONCLUDING STATEMENT
Thank you very much for your time, (MriMrsiMs.) (RESPONDENT'S LAST NAME), That concludes our interview for
today. We really appreciate your willingness to answer our questions and to participate in this important study. You've been
very helpful.
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS SOON AS POSSIBLE.
mwpsr^EPADAnwOIW&J'OSTQJ.Bl'A
PAGE 4
-------
The Environmental Study
Post-Monitoring Questionnaire
(HOUSEHOLD)
1997
PARTICIPANT ID#: 11-111
-------
INTERVIEW INFORMATION
PARTICIPANT ID#: LJ-LJ	1
RECORD: 1 0 I 1 I	SUBRECORD: I 0 I 0 1	VERSION: ' 0 ' 1

INTERVIEWER
ED#
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
! 1 1
1 1 111 II M
1 1 I I 1 1 AM/py

COMPLETE	1

MM DD YY


INCOMPLETE	2
02
! 1 1
I 1 11 1 II 1 1
1 1 II 1 1 AM/DM
1 1 I I 1 1 AM/PM
COMPLETE	; . 1
MM DD YY
INCOMPLETE ...... 2



03
j 1 1
1 Ml I III 1
1 I 1 • 1 1 1 AM'PM
1 1 1 • 1 1 1 AM/PM
COMPLETE	1
MM DD YY




lNCUMrLc It ...... 2
04
j 1 1
1 1 II 1 II II
1 I 1 • 1 1 1 AM/PM
1 1 1 • 1 1 1 AM/PM
COMPLETE	1
MM DD YY





REASONS FOR NONCOMPLETION:
01
02
03
04
RESPONDENT'S COOPERATION WAS:	VERY GOOD 		 1
GOOD 	...2
FAIR	 3
POOR	4
THE OVERALL QUALITY OF THIS	HIGH QUALITY	 1
INTERVIEW WAS:	GENERALLY RELIABLE 				 2
QUESTIONABLE			(SPECIFY BELOW). .. 3
UNSATISFACTORY 	(SPECIFY BELOW)... 4
REASON(S) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
QS/OQ/9?
-------
The Environmental Study
Past-Monitoring Questionnaire/Household
I would like to ask. you some questions about the daily activities of (CHILD'S NAME) during the 48-hour air monitoring
period, that is from 			 to	^	 . First,
1. Did (CHILD'S NAME) do anything during the 48-hour period that brought (him/her) near any of the following materials,
places, or activities?
MATERIALS, PLACES, OK ACTIVITIES
YES
NO
IF YES, WHERE
a. freshly applied paint	
1
2

b, food being fried, grilled, or barbecued		
1
2

c. burning of rubbish, garbage, or yard waste 	
1
<">
Jm

d. other open flames, including barbecue flames, fires	
1
1
Jm

e. glues or other adhesives	
1
2

f. solvents, fumes, or odorous chemicals	
1
2

g. floor wax, furniture wax, or shoe polish . 				
1
2

h. gasoline- or diesel-powered equipment other than
automobiles, including lawn mowers	
1
2

i. household cleaning agents, such as scouring powders or
ammonia					
1
2

j. excessive dust in the air	
1
2

k, stain or spot removers 			
1
2

1. gas station or auto repair shop 	
1
2

m. around where someone was pumping gasoline	
1
2

n. around a gas range or oven when it was used	
1
2

o. around a microwave oven when it was used	
1
2

p. freshly applied insecticides or pesticides (used to kill
insects, rodents, etc.) 			
1
2

q. freshly applied herbicides such as weed killers (in farm
fields or gardens)	
1
2

r. roofing tar or road tar			
1
2

s. around someone who was changing automobile oil	
1
2

t. Fungicides (to kill fungal growth and mold) 			
1
2

u. Disinfectants (Lysol, etc.) 	
1
2

v. Detergents/soaps 		
1
2

N-\WMI\£Pir>A YK\FORMSV*OST-Q2.EPA
PAGE 1
omm7
-------
The Environmental Study
Post-Monitoring Questionnaire/Household
MATERIALS, PLACES, OR ACTIVITIES
YES
NO
IF YIS, WHERE
w. Degreasers (for car/engine repair) 	
1
2

x. Kerosene 	
1
2

y. Lighter fluid				
1
2

z. Charcoal	
1
2

aa, Natural gas			
1
2

2.	3.	4.
Did (CHILD'S NAME) take
any vitamins or medications
during the 48-hour period?
What kind of vitamins or medications did
(he/she) take?
How much did (he/she) take?

Name
Amount
YES 			1
NO	(GO TO 5)	2
a.
a.

b.
b.

c.
c.

c.
c.



N:\WPSJ\EPADA YK^ORMS^POST Q2. EPA
PAGE 2
05/0W97
-------
The Environmental Study
Fost-Monitoring Questionnaire/Household
6.
Did you use your (HEATING SYSTEM/HEATERS) during the 48-
hour period? IF YES, ASK #6.
About how many hours a day during the 48-hour
period was it used?
IJT? A CVCTCM/UI1 A TCUC
llrLA lli>vi ft i dlRivi/niiiii LJCiAij
YES
NO
HOURS/DAY
a. Central electric heat



1

1
2

b. Central gas heat



1


1
2

c. Kerosene space heater



1


1
2

d. Electric space heater
1





2

e. Fireplace






1
2

f. Wood stove
1





2

g. OTHER (SPECIFY)






1
2







h. OTHER (SPECIFY)






1
2







i. OTHER (SPECIFY)






1
2







7.	Did anyone smoke cigarettes, cigars, or a pipe inside your	YES 			1
home during the 48-hour period?	NO	(GO TO 9) 		 2
8.	About how many cigarettes, cigars, or pipesful of tobacco	I I 1 I 1 I I 1 I
were smoked inside your home during the 48-hour period?	CIGARETTES CIGARS PIPES
9.	Did someone vacuum the floor inside your home during	YES 						1
the 48-hour period?	NO 			2
.V VW'S AiW/M YeirOkMSVOST-Q!.£i>A
PAGE 3
ornmr
-------
The Environmental Study
Post-Monitoring Questionnaire/Household
10, Did you or someone cook inside the house during the 48-hour YES 			
period?	NO	(GOTO 13)
, 1
.2
11, About how many hours did you (or someone) cook in the house
during the 48-hour period?
HOURS I	I	I MINUTES
12. What (appliance) was used to cook in the house during the 48-
hour period?
13. Did vou or someone cook outside the house during the 48 hour YES
period?	NO .
(GOTO 17)
	.2
14. Where did you (or someone) cook outside the house during the
48-hour period?
15. About how many hours did you (or someone) cook outside the
house during the 48-hour period?
L_U
HOURS I	1	1 MINUTES
16. What (appliance) was used to cook outside the house during the
48-hour period?
17. Did you or someone apply any of the following chemicals in
or around your home during the 48-hour period?

YES
NO
IF YES, WHERE AND WHEN?
1. insecticides or
1
2
WHERE:
pesticides (used to



kill insects,



rodents, etc.);


WHEN:
2. herbicides such as
1
2
WHERE:
weed killers (in



farm fields or



gardens); or


WHEN:
3. Fungicides (to kill
1
2
WHERE:
fungal growth and



mold).






WHEN:
N:\Y/PSl\£PADAYKfORMSiPOn-.Q2.EPA
PAGE 4
05M/37
-------
The Environmental Study
Post-Monitoring Questionnaire/Household
18. What is the highest grade or level of	11TH GRADE OR LESS 	 1
schooling that you have completed?	HIGH SCHOOL GRADUATE OR CED 			2
POST-HIGH SCHOOL TRAINING OTHER THAN
DO NOT READ CHOICES	COLLEGE (E.G., VOCATIONAL OR TECHNICAL TRAINING) 	3
SOME COLLEGE 					4
GRADUATED FROM COLLEGE	5
POST-GRADUATE EDUCATION	6
RF	..			7
DK 	8
Now I would like to ask you some questions about your opinions on this study.
19. Do you feel that any of the following activities was too much of a burden, too confusing, or caused too much
inconvenience to you and your family? [READ LIST:]
YES NO	IF YES, WHY?
a.	Collecting urine samples 				1	2
b.	Collecting food samples		1	2
c.	Collecting hand-wipe samples 		1	2
d.	Recording Child Activity Diary		1	2
e.	Air sampling inside your home 		1	2
f.	Air sampling outside your home 		1	2
g.	Doing the interviews with us 	:		1	2
h.	Dust sampling inside your home 		1	2
NAWPSMMDAYK^OXMS^OST-QIEPA
PAGES
OS/12/97
-------
The Environmental Study
Post-Monitoring Questionnaire/Household
20. Do you have any comments or suggestions about the	YES 			 1
study?	NO 					 2
CONCLUDING STATEMENT
Thank you very much for your time, (MrJMrsiMs.) (RESPONDENT'S LAST NAME). That concludes our interview for
today. We really appreciate your willingness to answer our questions and to participate in this important study. You've been
very helpful.
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS SOON AS POSSIBLE.
very helpful.
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
N.\WPSJS£PADA YK\FORAf$WOST~ Q2. EPA
PAGE 6
6S/1W7
-------
The Environmental Study
Child Activity Diary/Day Care Center
[	3
U-LLJ
Child's Activity Days
First Day
Second Day
Third Day






-------
first Day Time Period:	Day:	Date:
From the time the air monitor was set up until the child left the day care center.
Page
The air monitor was set up at (time):
2. The child left the day care center at (time):
k Did the child do any of the following things during this period of time? (You may check more than one)
~
1. Playing in the playground.
~
9. Playing on the floor inside the day care.
~
2, Walking barefoot in the playground.
~
10. Eating on the floor inside the day care.
~
3. Digging in the playground, contacting soil.
~
11. Walking barefoot inside the day care.
~
4. Eating dirt or sand.
~
12. Washing hands before eating.
~
5. On a field trip away from the day care.
~
13. Washing hands after playing outside.
~
6. Eating in a restaurant..
~
14. Doing art work, contacting paint or glue.
~
7. Eating outside the day care (picnic).
~
15. Sucking thumb, fingers, or toe.
~
8. Putting toys in the mouth.
~
16. Sleeping on the floor.


~
17. Playing with a cat or dog.
. Did the child follow the classroom's daily schedule?
~ Yes ~ No; if No, please explain:
5. Where did the child spend times inside the day care center?
6. Where did the child spend times outside the day care center
(You may check more than one)
(You may check more than one):
~ 1. His/her classroom ~ 2. Bathroom
~ 1. The playground ~ 2. Other places
~ 3. Cafeteria ~ 4. Other rooms/places
If you check #2, please write down the names of the othc
If you check #4, please write down the names of the other
places:
rooms/places:
•
7. When the child was at the day care center, how long (hours, minutes)
did he/she stay outside the day care center?
8. Did you take the hand wipe sample before the child washed hands and prepared for lunch?
~ Yes
~ No
9. Did you take the child's urine sample after the lunch and before the afternoon snack?
~ Yes
~ No
10. Did the child eat his/her lunch? ~ All of it
~ Most of it ~ Some of it
~ Did not eat

...snacks? ~ All of it
~ Most of it ~ Some of it
~ Did not eat

11. Did the child drink water at the day care? ~ Yes
~ No


S:\WP5l\EPADA YXJFO&M&EPADA Y.OIA
May 7.1997
-------
Page 2
Second Day Time Period:
Day:
Date:
From the time the child arrived at the day care center until the child left the day care center.
The child arrived at the day care center at (time):
2. The child left the day care center at (time):
Did the child do any of the following things during this period of time? (You may check more than one)
~ 9, Playing on the floor inside the day care.
~	1. Playing in the playground,
~	2. Walking barefoot in the playground.
~	3. Digging in the playground, contacting soil
~	4. Eating dirt or sand.
~	5. On a field trip away from the day care.
~	6. Eating in a restaurant.
~	7. Eating outside the day care (picnic).
~	8. Putting toys in the mouth.
~	10. Eating on the floor inside the day care.
~	11. Walking barefoot inside the day care.
~	12. Washing hands before eating.
~	13. Washing hands after playi ng outside.
~	14. Doing art work, contacting paint or glue.
~	15. Sucking thumb, fingers, or toe.
~	16. Sleeping on the floor.
~	17. Playing with a cat or dog.
k Did the child follow the classroom's daily schedule? ~ Yes
~ No; if No, please explain:
5. Where did the child spend times inside the day care center?
6. Where did the child spend times outside the day care center'
(You may check more than one)
(You may check more than one):
~ 1. His/her classroom ~ 2. Bathroom
~ 1. The playground ~ 2. Other places
~ 3. Cafeteria ~ 4. Other rooms/places
If you check #2, please write down the names of the othc
If you check #4, please write down the names of the other
places:
rooms/places:

7. When the child was at the day care center, how long (hours, minutes)
did he/she stay outside the day care center?	I®"
3. Did you take the hand wipe sample before the child washed hands and prepared for lunch?
~ Yes
~ No
3. Did you take the child's urine sample after the lunch and before the afternoon snack?
~ Yes
~ No
10. Did the child eat his/her breakfast?	~ All of it ~ Most of it ~ Some of it ~ Did not eat
...lunch?	~ All of it ~ Most of it ~ Some of it ~ Did not eat
...snacks?	~ All of it ~ Most of it ~ Some of it ~ Did not eat
11. Did the child drink water at the day care? ~ Yes	~ No
mwmSEPADA WOMMfAM I'.PM
Mat 7, J 997
-------
Page 3
phird Day Time Period:	Day:	Date:
From the time the child arrived at the day care center until the study staff's visit.
The child arrived at the day care center at (time):
2. The study staffs visit was at (time):
Did the child do any of the following things during this period of time? (You may check more than one)
~	1. Playing in the playground.
~	2. Walking barefoot in the playground,
~	3. Digging in the playground, contacting soil.
~	4. Eating dirt or sand.
~	5. On a field trip away from the day care.
~	6. Eating in a restaurant.
~	7. Eating outside the day care (picnic).
~	8. Putting toys in the mouth.
~	9, Playing on the floor inside the day care.
~	10. Eating on the floor inside the day care.
~	11. Walking barefoot inside the day care.
~	12. Washing hands before eating.
~	13. Washing hands after playing outside.
~	14. Doing art work, contacting paint or glue.
~	15. Sucking thumb, fingers, or toe.
~	16. Sleeping on the floor.
~	17. Playing with a cat or dog.
k Did the child fol low the classroom's daily schedule? ~ Yes
~ No; if No, please explain:
5. Where did the child spend times inside the day care center?
6. Where did the child spend times outside the day care center*.
(You may check more than one)
(You may check more than one):
~ 1. His/her classroom ~ 2. Bathroom
~ 1, The playground ~ 2. Other places
~ 3. Cafeteria ~ 4. Other rooms/places
If you check #2, please write down the names of the othe
If you check #4, please write down the names of the other
places:
rooms/places:

7. When the child was at the day care center, how long (hours, minutes)
did he/she stay outside the day care center?
8. Did the child eat his/her breakfast?
~ All of it
~ Most of it
~ Some of it
~ Did not eat
9. Did the child drink water at the day care?
~ Yes
~ No


N:\WPS MPADAYKkFORMS^PADA Y.D1A
May 7,199?
-------
Thank you for your participation in this important environmental
study. Your assistance in collecting the samples and recording the
child activity diary is critical to the success of this study.
If you have any questions regarding the sample collection or any
other study issues, please do not hesitate to contact us. You may
reach Christopher Lyu at (919) 544-3717 from 9 a.m. to 4:30 p.m.,
or Frances Patterson at (919) 408-0541 after 5:30 p.m.	'
CIBaueiie
,.. Putting Technology To Work
Centers for Public Health Research and Evaluation
100 Capitols Drive, Suite 301
Durham, North Carolina 27713
Telephone: (919) 544-3717
Fax; (919) 544-0830
-------
Thank you for your participation in this important environmental
study. Your assistance in collecting the samples and recording the
child activity diary is critical to the success of this study.
If you have any questions regarding the sample collection or any
other study issues, please do not hesitate to contact us. You may
reach Christopher Lyu at (919) 544-3717 from 9 a.m. to 4:30 p.m.,
or Frances Patterson at (919) 408-0541 after 5:30 p.m.	
ClBatreiie
... Putting Technology To Work
Centers for Public Health Research and Evaluation
100 Capitola Drive, Suite 301
Durham, North Carolina 27713
Telephone: (919) 544-3717
Fax; (919) 544-0830
-------
The Environmental Study
Child Activity Diary/Household
[ 1
U-LJ	I
0	0	0	0

>Wake Up Time
Time Leave Homeo
£>Time Arrive at Day Care
Time Leave Day CareO
>Time Arrive at Home
Bed Time C
First Day
At Home
At Day Care
At Home (page 1)
Second Day
At' Hcwnie '(page 2);
At Day Care
At Home (page 3)
Third Day
At Home (page 4)
At Day Care
At Home
¦ft The shaded areas are the time periods to be recorded in this child activity diary. It is about
the same as the 48-hour air monitoring period.
-------
Page 1
First Day Time Period:	Day:	Date:
From the time your child returned home from the day care center until his/her bed time.
L. Time your child returned home from the day care center:
2. Time your child went to bed:
L Did your child do any of the following things during this period of time? (You may check more than one)
~	1. Playing in the yard.
~	2. Walking barefoot in the yard.
~	3. Digging in the yard.
~	4. Eating dirt or sand.
~	5. Going somewhere away from home.
~	6. Eating in a restaurant,
~	7. Eating outside the house.
~	8. Putting toys in the mouth.
~	9. Playing on the floor inside the house.
~	10. Eating on the floor inside the house.
~	11. Walking barefoot inside the house.
~	12. Washing hands before eating.
~	13. Washing hands after playing outside.
~	14. Taking a bath.
~	15. Sucking thumb, fingers, or toe.
~	16. Sleeping on the floor.
~	17. Playing with a cat or dog.
i. Where (which room) did your child spend most time inside
your home during this period of time:
5. Where did your child spend most time outside your hom<
during this period of time:
5. Where else (other rooms) did your child spend time inside
your home:
7. Where else did your child spend time outside your home:
8. After your child returned home from the day care center,
how long (hours, minutes) did he/she stay outside your home?
9. Did you take the hand wipe sample before your child took a bath?
~ Yes
~
No
10. Did you take the urine sample after dinner and before your child went to bed?
~ Yes
~
No
11, Did you collect the same amount of foods that your child ate and drank?
~ Yes
~
No
12, Please write down any snacks and dinner your child ate and drank (including water) during this period of time:
-------
Page 2
Second Day Time Period 1:	Day:	Date:
From the time your child woke up until the time he/she went to the day care center.
Time your child woke up:
2, Time your child went to the day care center:
5. Did
your child do any of the following things during this period of time? (You may check more than one)
~
1.
Playing in the yard.
~
9. Playing on the floor inside the house.
~
2.
Walking barefoot in the yard.
~
10. Eating on the floor inside the house.
~
3.
Digging in the yard.
~
11. Walking barefoot inside the house.
~
4.
Eating dirt or sand.
~
12. Washing hands before eating.
~
5.
Going somewhere away from home.
~
13. Washing hands after playing outside.
~
6.
Hating in a restaurant.
~
14. Taking a bath
~
7.
Eating outside the house.
~
15. Sucking thumb, fingers, or toe.
~
8.
Putting toys in the mouth.
~
16. Sleeping on the floor.



~
17. Playing with a cat or dog.
Where (which room) did your child spend most time inside
your home during this period of time:
5. Where did your child spend most time outside your hom<
during this period of time;
5. Where else (other rooms) did your child spend time inside
your home:
7. Where else did your child spend time outside your home:
3. After your child woke up and before he/she went to the day care center,
how long (hours, minutes) did he/she stay outside your home? «¦
?. Did you take the urine sample after your child woke up?
~ Yes
~ No
10. Did you collect the same amount of foods that your child ate and drank?
~ Yes
~ No
11. Please write down any snacks and breakfast your child ate and drank {including water) during this period of time:
-------
Page 3
Second Day Time Period 2:	Day:	Date:
From the time your child returned home from the day care center until bed time.
Time your child returned home from the day care center
2. Time your child went to bed:
Did your child do any of the following things during this period of time? (You may check more than one)
Q 1. Playing in the yard.
~	2. Walking barefoot in the yard,
~	3. Digging in the yard.
~	4. Eating dirt or sand.
~	5. Going somewhere away from home.
~	6. Eating in a restaurant.
~	7. Eating outside the house.
~	8. Putting toys in the mouth.
~	9. Playing on the floor inside the house.
~	10. Eating on the floor inside the house.
~	11. Walking barefoot inside the house.
~	12. Washing hands before eating.
~	13. Washing hands after playing outside.
~	14. Taking a bath.
~	15. Sucking thumb, fingers, or toe.
~	16. Sleeping on the floor.
~	17. Playing with a cat or dog.
, Where (which room) did your child spend most time inside
your home during this period of time:
5. Where did your child spend most time outside your homi
during this period of time:
i. Where else (other rooms) did your child spend time inside
your home:
7. Where else did your child spend time outside your home:
i. After your child returned home from the day care center,
how long (hours, minutes) did he/she stay outside your home? «¦
Did you take the hand wipe sample before your child took a bath?
~
Yes
~
No
0. Did you take the urine sample after dinner and before your child went to bed?
~
Yes
~
No
1. Did you collect the same amount of foods that your child ate and drank?
~
Yes
~
No
2. Please write down any snacks and dinner your child ate and drank (including water) during this period of time:
-------
Page 4
Third Day Time Period: :	Day:	Date:
From the time your child woke up until the time he/she went to the day care center.
1. Time your child woke up:
2. Time your child went to the day care center:
3, Did your child do any of the following things during this period of time? (You may check more than one)
~
1. Playing in the yard.
~
9. Playing on the floor inside the house.
~
2. Walking barefoot in the yard.
~
10. Eating on the floor inside the house.
~
3. Digging in the yard.
~
11. Walking barefoot inside the house.
~
4. Eating dirt or sand.
~
12. Washing hands before eating.
~
5. Going somewhere away from home.
~
13. Washing hands after playing outside.
~
6. Eating in a restaurant.
~
14. Taking a bath
~
7. Eating outside the house.
~
15. Sucking thumb, fingers, or toe.
~
8. Putting toys in the mouth.
~
16. Sleeping on the floor.


~
17. Playing with a cat or dog.
4. Where (which room) did your child spend most time inside
your home during this period of time:
5. Where did your child spend most time outside your hom
during this period of time:
6. Where else (other rooms) did your child spend time inside
your home:
7. Where else did your child spend time outside your home:
8. After your child woke up and before he/she went to the day care center,
how long (hours, minutes) did he/she stay outside your home?
9. Did you take the urine sample after your child woke up?
~ Yes
~ No
10. Did you collect the same amount of foods that your child ate and drank?
~ Yes
~ No
11. Please write down any snacks and breakfast your child ate and drank (including water) during this period of time:
-------
CHILD'S USUAL EATING HABITS
This brief survey is about your child's usual eating habits over the past year. Please took at the following
food items and think about how often, on average, your child ate or drank each of the food item. If you're not
sure about an answer, please give your best guess. You may answer in per day, per week, or per month.
For examples, if once per dav. you write "0 1" in the boxes and circle "1M tinder the "day" column.
If never or rarely ate a food item, you just write 0 0 in the boxes.
The results will look like this...
No. of times



don't
(00-rarely/never)
day
week
month
know
10| 11
©
2
3
8
10101
1
2
3
8
FOOD ITEMS
Over the past year how often did your child eat?
WRITE No. OF TIMES
CIRCLE THE NUMBER FOR DAY, WEEK,
OR MONTH
[Less than once per month=Rarely/Never=00]
No. of times
(00=rarely/never)
day
week
month
don't
know
1. Apples, applesauce, pears
1 1 I
1
2
3
8
2. Cantaloupe (in season)
1 1 1
1
2
3
8
3. Oranges
1 1 \
1
2
3
8
4. Orange juice or grapefruit juice
1 1 1
1
2
3
8
5. Grapefruit
1 1 1
1
2
3
8
6. Other fruit juices, fortified fruit
drinks
1 1 1
1
2
3
8
7. Beans such as baked beans, pintos,
kidneys, limas, or in chili
1 1 1
1
2
3
8
8. Tomatoes, tomato juice
1 1 1
1
2
3
8
N:\WP5 J SEP AD A YK\FORMS\FOGD.DI A
PAGE 1
May 8,I997
-------

FOOD ITEMS
Over the past year how often did your child eat?

¦WRITE No. OF TIMES
CIRCLE THE NUMBER FOR DAY, WEEK,
OR MONTH
[Less than once per month=Rarely/Never=00]
No. of times
(00=rarely/never)
day
week
month
don't
know
9
Broccoli
1 1 1
1
2
3
8
10.
Spinach
1 1 1
1
2
3
8
11.
Mustard greens, turnip greens,
collards
III
1
2
3
8
12.
Cole slaw, cabbage, sauerkraut
1 1 1
1
2
3
8
13.
Carrots, or mixed vegetables
containing carrots
1 1 1
1
2
3
8
14.
Green salad
1 1 1
1
2
3
8
15.
Salad dressing, mayonnaise
(including on sandwiches)
1 1 1
1
2
3
8
16.
French fries and fried potatoes
1 i I
1
2
3
8
17.
Sweet potatoes, yams
1 i I
1
2
3
8
18.
Other potatoes, including boiled,
baked, potato salad, mashed
1 1 1
1
2
3
8
19.
Rice
[ i 1
1
2
3
8
20.
Hamburgers, cheeseburgers,
meatloaf
1 I 1
1
2
3
8
21.
Beef (steaks or roasts)
1 1 1
1
2
3
8
22.
Beef stew or pot pie with carrots,
other vegetables
1 1 1
1
2
3
8
23.
Liver, including chicken livers
1 1 i
1
2
3
8
24.
Pork, including chops, roasts
1 1 1
1
2
3
8
25.
Fried chicken
1 1 1
1
2
3
8
NAWPSi^EPADA.YK\FORMS\FOOD.DIA
PAGE 2
MayS, 2997
-------

FOOD ITEMS
Over the past year how often did your child eat?

WRITE No. OF TIMES
CIRCLE THE NUMBER FOR DAY, WEEK,
OR MONTH
[Less than once per month=Rarely/Never=00]
No, of times
(00=rarely/never).
day
week
month
don't
know
26.
Chicken or turkey, baked, roasted,
stewed or broiled
1 1 1
1
2
3
8
27.
Fried fish or fish sandwich
Mi
1
2
3
8
28.
Other fish, broiled or baked
1 1 I
1
2
3
8
29.
Spaghetti, lasagna, other pasta with
tomato sauce
1 1 1
1
2
3
8
30.
Hot dogs
1 1 i
1
2
3
8
31.
Ham, lunch meats
1 1 I
1
2
3
8
32.
Vegetable soup, vegetable beef,
minestrone, tomato soup
1 1 1
1
2
3
8
33.
White bread (including sandwiches),
bagels, crackers, etc.
1 1 1
1
2
3
8
34.
Dark bread, including whole wheat,
rye, pumpernickel
III
1
2
3
8
35.
Com bread, corn muffins, corn
tortillas
1 1 1
1
2
3
8
36.
Salty snacks (such as chips, popcorn,
pretzels)
1 1 1
1
2
3
8
37.
Peanuts, peanut butter
1 I f
1
2
3
8
38.
Margarine on bread or rolls
1 1 1
1
2
3
8
39.
Butter on bread or rolls
i 1 1
1
2
3
8
40.
High fiber, bran or granola cereals,
shredded wheat
1 1 1
1
2
3
8
41.
Highly fortified cereals, such as "
Product 19, Total, or Most

1
2
3
8
N:\WP5I\EPADAYK\FORMS\FOOD.DIA
PAGE 3
May 8,199?
-------

FOOD ITEMS
Over the past year how often did your child eat?

WRITE No. OF TIMES
CIRCLE THE NUMBER FOR DAY, WEEK.
OR MONTH
[Less than once per month=Rarely/Never=00]
No. of times
(00=rarely/never)
day
week
month
don't
know
42.
Other cold cereals, such as Com
Flakes, Rice Kri spies, Cheerios
1 1 1
1
2
3
8
43.
Cooked cereals
1 1 1
1
2
3
8
44.
Eggs
i 1 1
1
2
3
8
45.
Bacon
I 1 1
1
2
3
8
46.
Sausage
1 1 1
1
2
3
8
47.
Ice cream
1 1 1
1
2
3
8
48.
Doughnuts, cookies, cakes, pastry
1 1 1
1
2
3
8
49.
Pies
1 1 1
1
2
3
8
50.
Chocolate candy
1 1 f
1
2
3
8
51.
Cheeses and cheese spreads, not
including cottage cheese
1 1 1
1
2
3
8
52.
Whole milk and beverages with
whole milk (including on cereal)
1 1 1
1
2
3
8
53.
2% milk and beverages with 2%
milk (including on cereal)
I ! 1
1
2
3
8
54.
Skim milk, 1 % milk or buttermilk
(including on cereal)
i I 1
1
2
3
8
55.
Regular soft drinks (not diet)
1 1 1
1
2
3
8
56.
Milk or cream in coffee or tea
1 1 1
1
2
3
8
57.
Sugar in coffee or tea, or on cereal
1 1 1
1
2
3
8
The following foods are from restaurants





58.
Fried chicken from restaurants
I 1 I
1
2
3
8
N:\WP5 l\EPADAYK\FORMS\FOOD.DlA
PAGE 4
May i, 199?
-------

FOOD ITEMS
Over the past year how often did your child eat?

WRITE No OF TIMES
CIRCLE THE NUMBER FOR DAY, WEEK,
OR MONTH
[Less than once per month=Rarely/Never=00]
No. of times
(00=rarely/riever)
day
week
month
don't
know
59.
Burgers from restaurants
1 1 1
1
2
3
8
60.
Pizza from restaurants
1 1 1
1
2
3
8
61.
Chinese food from restaurants
1 1 1
1
2
3
8
62.
Mexican food from restaurants
1 1 1
1
2
3
8
63.
Fried fish from restaurants
1 1 1
1
2
3
8
64.
Barbecue from restaurants
1 1 1
1
2
'3
8
N\WP5l\EPADAYfC\F0RMS\F00D.DIA
PAGE 5
May 8,1997
-------
Thank you for your participation in this important environmental
study. Your assistance in collecting the samples and recording the
child activity diary is critical to the success of this study.
If you have any questions regarding the sample collection or any
other study issues, please do not hesitate to contact us. You may
reach Christopher Lyu at (919) 544-3717 from 9 a.m. to 4:30 p.m.,
or Frances Patterson at (919) 408-0541 after 5:30 p.m.	
pBatteiie
... Putting Tecfmo/qgy To YJotk
Centers for Public Health Research and Evaluation
100 Capitoia Drive, Suite 301
Durham, North Carolina 27713
Telephone: (919} 544-3717
Fax:(919)544-0830
-------
Day Care Location & Surrounding Area
ID; D03
Hp Soil sampling location
OM Outdoor air monitor
North


Stieei




Sampled Classrooms
OM Back
ParJ-ing Lot
DI First dost sample area, Sample Date: 06106197	Ceiling; 10'
fEH Second dost sample area
IM
Indoor air monitor location
OM Outdoor air monitor
Hallway
M
?==-
.¦m.-, ...
IV»
O
Classroom #2
r
Front oftrailding
Hallway
|	 21.5' 	1
V
Classroom#!
M
41'
OM
r
a
Back ofVuildirtg
-------
Day Care Location & Surrounding Area
ID: D09
Sod, sampling IccatieH
OM Outdoor air wozi*
.ft
skJH?

£ > .« -> %%¦	*-%... 4*jt'
&X Ajd 4. It:"- Jfc 7
M £W *'4ir	J*, -f'
> .,,5*^ . '&Uw3T	.f V;f^ •$»
6 • iS
* A •
toUfflg#1 If %'; :'•
/¦I J&f"*11*	Back IfU
/ & 	^-T'"'


¦T; » 0 *
Mji(	,/
"f. ***"" 4$* $ RiiWif«#2

v'	--v^A ^
sfr
^ . ..«•£»("•• -,'.*	it'?'-'! .* .<»! ^ * • !- '!r
fill
-*f;:
	 :
*
Sampled Cksssoosss
D1 ^ Fiist dust sample area
:|Pp5 Second dust sample area
0 Indoor air monitor location
Sample Date: 06/13/97
Ceiling:
46'
-24.5'-
Classroom #1
SI
J
Haftvay
[7
H
usar
IM
\
•3
o
Classroom Ml
\
-------
House Location & Surrounding Area 3D: HAS
Cj®) Soil sampling location
OM Outdoor air monitor

Abandoned house
Front porch
WKBSSBBSKSBmBSm
House Floor Han
DB First iuit sample area
»
Sample Date: 06B4/97
Ceiling: 8'
House is Aout 1,280 SF
fflt
Indoor air monitor location
Back Deck
Bedroom &2
Bedroom #L
Room#!
Hallway
Living room
-------
House Location & Surrounding Are a 3D: HB3
IIP Soil sampling location
OM Outdoor air monitor
MS-'W* •" «•'	-.a
75' ¦	¥#"
fe ?% >'M

Fmnt door
ft!
Scat Iev«l house
Ullll
back door
B • Fenced V&ck^azd
fR m arai mi mr-m ¦¦¦¦¦¦» mm m w i ¦ w



r f.sifc*	mm-a
ZWfrP*	•* :V45ii®
Street
House floor Plsn
|J First dust sample area	Sample Date: 06/04S7
w*jt? Second dust sample area	JH Indoor air monitor location
%s8p*
Ceiling: 8'onboth floors
Housa is boat 1,330 SF
(L*W*1„5)
Dining Room
0
HL
Kitclieii
L ,
Mom
Bedroom ffi
Bath
room
D1
IM
Living Room
Bedsoom
#1
Sister
1/2 Bath
J	
Bedroom
#3
Robert
Upper Level
Front Door
™ •"¦¦& -n ,:.rn
J> *¦*"¦%•
-y i*
Backyard

OM .:
" «< •'¦¦-•# -n f% -f-A ¦*,
Storage Room
Sewing Room
Pky Room
Lower L#r»i
-------
House Location & Surrounding Area
Soil sampling location
ID: HC3
OM Outdoor air monitor
iit'i £r!;:4'• il
"*•	small Ml
" 'sh
•"V ,. ',1		
'* sfS' -k »:¦ C 	
-------
House Location & Surrounding Area
ID: HD3
1 Soil sampling location
OM Outdoor air monitor _
¦wm
If'-v	1 ^
.	1 **vmi
b-xsm
it .v A &(»•**' ¦'?•'"&#• #-»ji
Ji-v $6. i jfc
| rt' - .>****»* # * ' -
||p| «&/: vV&.i&S J -^v. 4$pg0 J
|r*y .ng
*V «S Ibfe *"*
*v -.%•*


»* S*0» 4- *«?**.
vf, -J >.-¦ -ftv.'.-ti ;••: &$, «?<*$?&	v|J. *
J6J 8* -.- 3Si-$'-i£	,,
t%Ji



2-Story
Public Honsix
ig Building

OM |
III
•wl**
«, „ *» •«j ¦'  i~?
•*>.'¦ ,	tti «< •i-
'jfc ?
> %vJf
•	* S s» ~ •»'• % * j
i- & k is- •¦-¦	v *. <,• .& -.f $-.3# ^ *: r **'
'«£ > »•;' ••¦•	-JT' "• »\ x •!?;>•';#
"¦•; >-..•¦&& ,{? •£,	^ •:. % r-jj
St «et
-
#• •„ :»¦ >5
98':- Iit >.-
House Ho or Han
;;;D1| E*»t out »ampM area
Sample Date: 06(05197
m
Indoor air monitor location
Ceiling: 3' on both floors
House is about 1,200 SF
Bach door
Kitchen and Diitng area	>»
IM
OM
Living Room

Bedroom
m
Mom
lit Floor
Bath
room
«
Bitk
Room
m
Hall

Bedroom S3
Bedroom W2.
Bedroom #1
with carpet
Hyeek
2nd Floor
-------
House Location & Surrounding Area
^Hsoil sampling location
ED: HE9
OM Outdoor air monitor
**% Ju
_ai
, ... >#£ "v 	
f ¦«
¦
?	3?	sr—v., Ji4t-—
a '>*
m ->*-*
. f%/"til
> *•

»¦
Deck
2-stoiy House
with a. Full Basement
' #£*
•J?

8Jsr"%$^
Fenced Backyard
% "im
;%
.f
.'J?
i % i
#T> 8	*5 it
•vs*
"> «•
teSirVt; 1- I $

it.	V>5? -S &
¦¦-' vi'
-' v v -iiif
102' ;f; r
#
•V A.-
; Jj. ,y
Stroel
a
House Hoar Han
First dust sample area
Sample Date: 06111197
fjl Second dost sample area M Iwioor air monitor location
Ceiling; 18" in Family Room
Beit about 9'
House is about 2,200 SF
Utility
Family Boom
Kitchen
lQBatii
LnrineRoom
1st Floor
] Fiteplace
Front Door
Mom
Batkffl
-------
House Location & Surrounding Area ID: HE9
Soil sampling location
OM Outdoor air monitor gggj
..	-i
,
-jA «»*• ;
-------
House Location & Surrounding Area ID; HG9
) Soil sampling location
•%* 4^ ri
OM] Outdoor air monitor ^
v'4 .'J?''"
a m 'fi#
vpS*

Stora$»
Room
~a|
f V*i 'f ^
ft fk •: ¦
" * is *4 ft •*
<> 'VCi
Front Porch !;..
'i4-'-.*:*	't* :;f	}':
'I
•S,WsH	I'
t
-s"' *'
4*^ .# ~
rtr? * -v a «
Street
House Moor Plan
ijgljll first dust sample area
Second dust sample area
Sample Date: 06/12/97
Ceiling: 128" in the Living Boom
Best is about 8'
House is about 1,280 SF
Uj Indoor air monitor location
Outdoor
Storage
Fireplace
Deck
Dii
ingirea
m
I
^81?'
Living Room
OM
Bedroom 03
Mom
Kitchen
lath#!
Bath #2
Utility
H
EC
Christian
Bedroom #1
Bedroom #2
Entrance Hall
Fsoat Porch
-------
House Location & Surrounding Area
Soil sampling location
OM| Outdoor air monitor
ID; HH9
W ,.m **¦ V*"P« •}•"	'***<» '¦< >*•»•,*
"" •	- ¦	*• & Wt	i',	Vti '# *• "**
3*2 a/J- »:

; v. % Vv *#•
* IP i# * SBBI StoM#'^ <-	•' f< *«g*
-5- , ' Vi
*«V
Shed
: •;'•

*
a

2-Stoiy House
Front Door
** a
!•- -< i"-yp	86.5'
'">• 4> i' fi
*6* «
c' & ?
¦!* i --i'l-.r
j i,. 'S- 4 "c :<$
¦¦%• «' C> 4. .9 •>•• •'¦¦'£&
S r £¦¦
& ;; ¦*,¦*, •
3 :> A ;:
'V* r>-
¦¦V if <:•¦>'&¦
' >¦* W** •£,•••!-: vj'-vx-.i * *
£¦ .j A sA-'Ss-W
•r i'i '.,
~ > c .<>
•'?' «. •-*.1.. •-*,•. ,^5.*
.« -V- 
Stjpp.t
House Moor Plan
Fust dust sample at»a
#
I Qlj Indoor m momtar loc»tkiii
Sampk Date: 06/12/9?
Ceiling: 8" on both floors
House is about 2,400 SF

Btdioom #3
Mom
1_ JJ%y_
Screen
P0Kh Bath®
(1/2 Bath)
Bath AO
Kitchen
Living Room
< Hall
Dining Boom
2AC
Wreck Hoom
Hall
David
Bedieor #1
Bath
#1
Sister
Bedxoont #2

Slid Floor
-------
House Location & Surrounding Area ID; HI9
OM
Soil sampling location
Outdoor air monitor 2 ?

i^«r • if	,>-t 'JfSp V r|S
•/'
./GwfcJf^ * • Pkyaj*a
¦¦•»
•>- S-»
' -'I -imSS-A i»
,V '
<•	^ •'•' v«-v :-.:T
1	;*' s^t >1	jV .•; ¦"' ^ i«
,&;* v * '%'"i4vv $ «*i»„ „..
«.*** _,;... -• ^ ^
••M t ".*' . 'w	'.ZttJ-fSfb-M.	-T~. 1	' ilO' -£• V.
Sf* ,-f <£
iV - ^^VS^VgS
s5- i.-'A-.
*s ^"jiiifiS^
^	V#
i ferv >•
J "
H:
mat-
Deck
OM
-¦ <$.+ '-
{¦$* ¦ •: > ••:
1 ?.*.('¦
2-Stor/ House
2-car
garage
r
v c 'jft-r •?>
^ -h;:- *¦¦«,':)¦ p;,:.*#
•Jrfc.v-^.' v£ * -<2: ;/:"*; X-Q.
,i!- «
ip|
1^111 ¦**" ^ 'A* ^ "*"" *"v''-~*$*'"'r
.. 67'
jFxont Pouch
"©
¦SI' V ^ >' :• <•?•".' 'vg ;-sij'
*•*, 4. <£> «•"? «•
»? -sjS v-

•"'- f> < §?jr.&
.&&&!
«? i' :v i," -.v -5>
-;> -J; o :i -a v«r,	t>*$ ®
f » '"*'• " '* '¦••"'•n.-*y, ^	^
14fe-4'?1&^*»-tsS<£••'"'T-?;	Sti^i ^ir^i ''
a	»Ai First dart sample area
I j Second (tut sample area
Sample Date: 0S/12S7
jjj Indoor air monitor location
CeJing: 3' on both floors
House is about 2,500 SF
Deck
Family Room
O
IMl
Living
Room
Hall
/
Kitchen — —
Dining Room
.3
Garage
Front Porch.
I si Floor
Badioom #1
Mom
Bath #1
Bath #2
ZndHam
-------
MEEL-RTP-O-57 9
TECHNICAL REPORT DATA


1. REPORT NO.
2.

3

600/R-98/164b
'

!
	 	
4. TITLE AND SUBTITLE


5.REPORT DATE

Evaluation and Application of Methods for Estimating Children's


Exposure to Persistent Organic Pollutants in Multiple Media
Volume II: Appendices A-C
6/PERFORMING ORGANIZATION CODE
7. AUIHOR(S)


8.PERFORMNG ORGANIZATION
REPORT NO.
Jane C, Chuang et a).




9. PERFORMING ORGANIZATION NAME AND ADDRESS

10.PROGRAM ELEMENT NO.
Battelle Memorial Institute


Projects E0608 and E0460
505 King Avenue


11. CONTRACT/GRANT NO.
Contract 68-D4-0023
Columbus, Ohio 43201


12. SPONSORING AGENCY NAME AND ADDRESS

13.TYPE OF REPORT AND PERIOD
COVERED
National Exposure Research Laboratory

Research Report

U. S. Environmental Protection Agency ;
Research Triangle Park, NC 27711

14. SPONSORING AGENCY CODE
EPA/600/09
15. SUPPLEMENTARY NOTES
16. ABSTRACT




Field methods for determining children's exposure to selected persistent organic pollutants (POP), including
polycyclic aromatic hydrocarbons and other semi-volatile organic compounds (SVOC) were evaluated and applied
to estimate the ranges of potential exposures through air, dust, and food, of a small set of children from low-income
and middle-income families. A field study was conducted at nine day care facilities, and a second field study was
conducted which measured the total exposures to multiple compound classes - polycyclic aromatic hydrocarbons
(PAH), polychlorinated biphenyls (PCD), phthalate esters (PE), phenols (Ph), organochlorine (OC) pesticides,
organophosphate (OP) pesticides, and a herbicide acid (HA) - of nine children selected from two of the day care
centers. Ingestion, both dietary and nondietary, was a primary route of exposure for many of the compounds, but
other routes were also important, depending on the compound class.
17.
KEY WORDS AND DOCUMENT ANALYSIS

a. DESCRIPTORS
b.IDENTIFIERS/ OPEN ENDED
TERMS
c.COSATI



18. DISTRIBUTION STATEMENT

19. SECURITY CLASS (This
Report)
21.NO. OF PAGES


Unclassified




20. SECURITY CLASS (This Page)
22. PRICE


Unclassified


-------