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Radon Resistant New Construction Report NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Environmental Radiation Protection 547 River Street, Room 530 Troy, NY 12180-2216 Name: _________________________________________________________________________________________________ Company Name: ________________________________________________________________________________________ Street Address: __________________________________________________________________________________________ Year: ______________________________ Period: January-June July-December (report due 30 days following end of the semi-annual period) City: __________________________________________________________________________________________________ State: __________________________________________________________________ Zip Code: ______________________ Email: _________________________________________________________________ Phone #________________________ (if necessary) Date of the Construction Zip Code Town or City County Passive System Radon Concentration (pCi/L) * EXAMPLE: Residential (ranch, 2 story colonial, etc) or Commercial (school, apartment building, etc) Page 1 of 2 DOH-5028 (2/11) Type of Building or house* Active System Radon Concentration (pCi/L) (if necessary) Date of the Construction Zip Code Town or City County Passive System Radon Concentration (pCi/L) * EXAMPLE: Residential (ranch, 2 story colonial, etc) or Commercial (school, apartment building, etc) Page 2 of 2 DOH-5028 (2/11) Type of Building or house* Active System Radon Concentration (pCi/L)