Document ID: EPA-HQ-ORD-2004-0009-0003
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2004-07-08T04:00Z

Version
7/
8/
04
1
INVENTORY
OF
ENVIRONMENTAL
PUBLIC
HEALTH
BIOMONITORING
PROGRAMS
AND
HEALTH
SURVEILLANCE
DATABASES
FOR
THE
MID­
ATLANTIC
REGION
Overview
The
Inventory
of
Environmental
Public
Health
Biomonitoring
Programs
and
Health
Surveillance
Databases
is
a
georeferenced
database
containing
metadata
about
environmental
health
programs.
Accessible
on
the
Internet,
this
database
will
allow
users
to
search
for
sources
of
relevant
data
for
a
given
use.
Possible
uses
include
baseline
assessment
of
public
health
and
the
environment,
targeting
environmental
activities
to
reduce
risk
to
human
health,
and
Homeland
Security.

Instructions
By
completing
this
inventory
form,
your
environmental
health
program
will
be
included
in
the
database.
Please
complete
a
form
for
each
data
collection
program
that
your
organization
has
operated
or
is
currently
operating.
Please
use
your
professional
judgment
as
to
the
level
of
program
or
site
activities
at
which
it
is
appropriate
to
report.

For
each
question,
fill
in
blanks
where
appropriate
and
check
all
boxes
that
apply.

*******************************************************************************

Date
questionnaire
completed
____________________

SECTION
A
­
GENERAL
INFORMATION
1.
Program
or
Network
Name
(
Full)
_______________________
(
Acronym)
_______________

2.
If
Project
or
Site,
Name
(
Full)
__________________________
(
Acronym)
_______________

3.
Program/
Project/
Area
Goal
or
Objectives
­
up
to
five
lines
4.
Coordinating
Agency
or
Institution
____________________________________
Program
contact
person:
____________________
Phone:
(
)
E­
mail:
Data
contact
person:
_____________________
Phone:
(
)
E­
mail:
Can
this
information
on
contact
people
be
made
public?
[
]
yes
[
]
no
5.
Funding
Agencies/
Institutions
(
check
the
appropriate
blocks
and
list
the
names
of
agencies)
[
]
Federal
__________________________________________
[
]
State
____________________________________________
[
]
Academic
________________________________________
[
]
Local
____________________________________________
[
]
Other
NGO
_______________________________________
[
]
Tribal
government
_________________________________
[
]
Consortium
______________________________________
[
]
International
______________________________________
[
]
Other
____________________________________________
Version
7/
8/
04
2
6.
Participating
Agencies/
Institutions
[
]
Federal
__________________________________________
[
]
State
____________________________________________
[
]
Academic
________________________________________
[
]
Local
____________________________________________
[
]
Other
NGO
_______________________________________
[
]
Tribal
government
_________________________________
[
]
Consortium
______________________________________
[
]
International
______________________________________
[
]
Other
___________________________________________
[
]
Volunteers
7.
Legal
Mandate
for
Project
[
]
yes
(
specify)
____________________________________
[
]
no
(
explain
why
collecting
data)
____________________________________________

8.
Stage
of
Data
Collection
[
]
in
planning
[
]
dormant,
will
restart
in
_________
(
year)
[
]
ramping
up
[
]
completed,
in
__________
(
year)
[
]
fully
operational
9.
Year
Data
Collection
Initiated:
_________

10.
Projected
Duration
of
Data
Collection
[
]
likely
long­
term
[
]
unlikely
long­
term
[
]
ending
in
___________
(
mo/
yr)

11.
Data
Availability
[
]
unrestricted
access
[
]
available
immediately
[
]
aggregate
formats
only
[
]
delayed;
available
in
________________________
[
]
location
confidentiality
restrictions
[
]
controlled
access
for
research
purposes
[
]
privacy/
confidentiality
protected
[
]
other
restrictions
(
specify)
__________________________

12.
Data
Accessibility
[
]
internet
[
]
CD­
rom
[
]
other
electronic
[
]
hard
copy
maps
[
]
hard
copy
tables
[
]
peer­
reviewed
publications
[
]
available
through
U.
S.
National
Technical
Information
Service
[
]
other
_________________________________
Version
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8/
04
3
13.
Electronic
Format
Information
(
for
data
integration
across
programs)
a)
Agency/
Organization
Level:
Platform
Storage
Format
Analysis
Software
[
]
PC
[
]
flat
file
________________________
[
]
Mac
[
]
hierarchical
database
________________________
[
]
UNIX
[
]
relational
database
________________________
[
]
Mainframe
[
]
spreadsheet
________________________
[
]
GIS
[
]
other
_______________

b)
Project
Level:
Platform
Storage
Format
Analysis
Software
[
]
PC
[
]
flat
file
_____________________________
[
]
Mac
[
]
hierarchical
database
_____________________________
[
]
UNIX
[
]
relational
database
_____________________________
[
]
Mainframe
[
]
spreadsheet
_____________________________
[
]
GIS
[
]
other
_______________

14.
Metadata
Standards
[
]
meets
FGDC
metadata
standards
[
]
meets
other
standards
(
please
describe)
_____________________________
[
]
no
standards
SECTION
B
­
PROGRAM
DESIGN
INFORMATION
15.
Monitoring
Design
[
]
[
]
Tier
I
­
census
For
mapping
overall
condition/
status
[
]
Tier
II
­
survey
For
regional
or
national
interpolation,
and/
or
summary
statistics
when
full
coverage
is
not
feasible
[
]
probability­
based
(
includes
stratified
random)
[
]
targeted
populations
or
systems
(
cluster
or
outbreaks)
[
]
fixed­
site
network
(
provides
interpolation
data)
[
]
Tier
III
­
intensive
data
collection
site(
s)
or
area
(
hospital
admissions,
or
epidemiological
study)
[
]
short­
term
response
to
outbreak
[
]
long­
term
(
for
understanding
human
health
processes
and/
or
short­
term
variability)

lat/
long:
_____________________
elevation
(
above
mean
sea
level)
___________
(
m)
closest
town:
____________________________
state:
_________

If
Tier
III,
Available
Resources
[
]
Field/
laboratory
infrastructure
(>
$
100,000
value)
[
]
Long­
term
data
record
(>
5
years)
[
]
Stable
sources
of
existing
funding
[
]
Likely
sources
of
new
funding
[
]
History
of
research
(
multiple
investigators
and
publications
for
>
5
years)
[
]
Active
data
collection
team
(
investigators,
nearby
technicians)
[
]
Field/
laboratory
research
space,
storage
facilities
How
do
we
reflect
Large
aggregated
Databases?

16.
Reporting
Area
Represented
by
Data
Collection
what
else
is
commonly
used?
[
]
political
unit
[
]
city
[
]
state
[
]
county
[
]
personal
exposure
monitoring
[
]
other
________________________
Version
7/
8/
04
4
Version
7/
8/
04
5
17.
Geographic
Extent
[
]
current
[
]
planned
[
]
single
county
[
]
single
county
[
]
multiple
counties
[
]
multiple
counties
[
]
single
state
(
or
territory/
possession)
[
]
single
state
(
or
territory/
possession)
[
]
multiple
states
(
territories/
possessions)
[
]
multiple
states
(
territories/
possessions)
[
]
national
[
]
national
[
]
international
[
]
international
18.
Number
of
People
(
or
should
this
be
site?
Should
we
have
a
question
about
what
constitutes
a
site?
Hospital,
city,
neighborhood?)
Current
________________
planned
_______________

19.
Method
of
Site
Observations
and/
or
Measurements
[
]
blood
[
]
urine
[
]
autopsy
[
]
tissue
registry
[
]
vital
signs
measurements
[
]
use
of
survey
questionnaire
[
]
hospital
admissions
records
[
]
other
method
(
describe)
____________________

20.
Most
Commonly
Used
Monitoring
Frequency
at
a
Given
Site
(
check
all
that
apply)
[
]
once
[
]
weekly
[
]
every
____
years
[
]
by
minute(
s)
[
]
monthly
[
]
continuous
[
]
hourly
[
]
seasonally
[
]
event
[
]
daily
[
]
annually
[
]
other
____________

21.
Rotation
Cycle
at
a
Given
Site
[
]
none
[
]
seasonally
[
]
annually
[
]
every
_____
years
Duration
of
sampling
period
____________________
(
units
of
time)
Duration
of
non­
sampling
period
____________________
(
units
of
time)
Beginning
date
of
most
recent
cycle
__________________

22.
Site
Size
or
Length
________________
(
units)

23.
Shape
of
Individual
Site
[
]
uniform
[
]
irregular
24.
Site
Location
Method
[
]
use
of
geographic
positioning
system
(
GPS)
[
]
known
accuracy
is
within
25
meters
[
]
other
method
of
estimating
site
location
(
landmarks/
other
­
describe)
______________

25.
Are
Specific
People
Revisited?
[
]
yes
[
]
no
Please
indicate
if
your
program
collects
the
following
information:

26.
Date
of
Data
Collection
[
]

27.
Time
of
Data
Collection
[
]
Version
7/
8/
04
6
SECTION
C
­
CIRCULATORY
28.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Cardiovascular
[
]
Blood­
Borne
[
]
Cancer
[
]
coronary
heart
disease
[
]
typhoid
[
]
leukemia
[
]
stroke
[
]
Lyme
disease
[
]
Non­
Hodgkin's
lymphoma
[
]
anemia
[
]
malaria
[
]
Hodgkin's
disease
[
]
blood
formation
effects
[
]
Rocky
Mountain
spotted
fever
[
]
Metabolic
[
]
rheumatic
fever
[
]
west
Nile
virus
[
]
diabetes
[
]
aplastic
anemia
are
these
diseases
which
affect
[
]
hypertension
the
circulatory
system,
or
just
blood
[
]
Alzheimer's
[
]
increased
blood
pressure
borne?
[
]
coronary
artery
disease
[
]
angina
[
]
cardiomypathy
[
]
Other
_______________

29.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

30.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)

SECTION
D
­
RESPIRATORY
31.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Chronic
Obstructive
Pulmonary
Disease
(
COPD)
[
]
Cancer
[
]
edema
[
]
bronchitis
[
]
lung
[
]
emphysema
[
]
nasal
passages
[
]
fibrosis
[
]
mesothelioma
[
]
asbestosis
[
]
Asthma
[
]
sinus
[
]
Farmers'
Lung
[
]
Pneumoconiosis
[
]
Methemoglobenemia
[
]
Fungal
Diseases
[
]
other
_______________

32.
Infectious
Agents
(
bacteria
&
viruses)
[
]
how
should
we
deal
with
these?
Crosscutting?
[
]
flu
[
]
anthrax
[
]
TB
[
]
other
___________________________
[
]
colds
[
]
pneumonia
33.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

34.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)
Version
7/
8/
04
7
SECTION
E
 
ENDOCRINE
35.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Metabolic
[
]
Hormonal
Dysfunction
[
]
Cancer
[
]
diabetes
[
]
testes
[
]
breast
[
]
other
_______________
[
]
prostate
[
]
other
______________

36.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

37.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)

SECTION
F
­
INTEGUMENTARY
38.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Cancer
[
]
chloracne
[
]
dermatitus
[
]
basal
cell
carcinoma
[
]
squamous
cell
carcinoma
[
]
malignant
melanoma
[
]
other
_______________

39.
Infectious
Agents
(
bacteria
&
viruses)
[
]
[
]
Staphylococcal
infections
[
]
other
_________________

40.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

41.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)

SECTION
G
­
MUSCULAR
42.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Muscle
Weakness
&
Paralysis
[
]
muscle
wasting
[
]
other
_______________

43.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

44.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)
Version
7/
8/
04
8
SECTION
H
­
NERVOUS
45.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
meningitis
[
]
headaches
(
migraines)
[
]
Cancer
[
]
encephalitis
[
]
clumsiness
[
]
Brain
[
]
polio
[
]
agitation
[
]
Neuroblastoma
[
]
peripheral
neuropathy
[
]
decreased
activity
[
]
other
[
]
Parkinson's
[
]
behavioral
diseases
[
]
Retinoblastoma
[
]
lyme
disease
[
]
nervous
tremors
[
]
Alzheimer's
[
]
retardation
[
]
twitching
[
]
Autistic
spectrum
disorders
[
]
wristdrop
or
footdrop
[
]
flicking
eyes
[
]
Rabies
[
]
visual
difficulties
[
]
changes
in
vision
[
]
lowered
intelligence
[
]
Attention
Deficit
Disorder
[
]
sensory
disturbances
in
legs
&
arms
[
]
cerebral
palsy
[
]
West
Nile
Virus
[
]
paralysis
[
]
multiple
sclerosis
[
]
Mad
Cow
Disease
[
]
other
_______________

47.
Infectious
Agents
(
bacteria
&
viruses)
[
]

48.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

49.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)

SECTION
I
­
REPRODUCTIVE
50.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Birth
Defects
(
congenital
anomalies)
[
]
Cancer
[
]
cardiac
defects
[
]
prostate
[
]
respiratory
defects
[
]
ovaries
[
]
short
gestation
(
pre­
term
births)
[
]
uterine
[
]
low
birth
weight
[
]
breast
[
]
nervous
system
defects
[
]
testes
[
]
oral
cleft
[
]
vaginal
[
]
urinary
tract
defects
[
]
cervical
[
]
neural
function
[
]
immune
function
[
]
Premature
puberty
[
]
perinatal
death
[
]
spontaneous
abortion
[
]
Lower
growth
rate
[
]
stillbirth
[
]
somatic
parameters
[
]
abnormalities
of
reproductive
organs
[
]
Reduced
fertility
[
]
cerebral
palsy
[
]
autism
[
]
mental
retardation
[
]
attention
deficit
disorder
[
]
tubal
pregnancies
51.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

52.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)
Version
7/
8/
04
9
SECTION
J
­
DIGESTIVE
53.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
cholera
[
]
Cancer
[
]
Chrohn's
Disease
[
]
cryptosporidiousis
[
]
liver
[
]
Ulcerative
colitis
[
]
ecoli
0157:
H7
[
]
stomach
[
]
hepatitis
[
]
prostate
[
]
A
[
]
B
[
]
C
[
]
pancreas
[
]
stomatitus
[
]
typhoid
fever
[
]
salmonellosis
[
]
shigellosis
[
]
giardiasis
[
]
yellow
fever
[
]
malaria
[
]
gastroenteritis
[
]
cirrhosis
of
the
liver
[
]
other
_______________

54.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

55.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)

SECTION
K
­
SKELETAL
56.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Osteoporosis
[
]
Cancer
[
]
Gout
[
]
bone
marrow
[
]
Fragile
bones
[
]
other
_______________
[
]
decreased
bone
density
[
]
osteomalacia
[
]
other
______________

57.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

58.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)

SECTION
L
­
URINARY
59.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Renal
[
]
Cancer
[
]
diabetes
[
]
bladder
[
]
hypertension
[
]
kidney
[
]
kidney
damage
[
]
Wilm's
tumor
[
]
end­
stage
renal
disease
(
ESRD)
[
]
tubular
necrosis
[
]
glomerulonephritis
[
]
other
__________________
[
]
other
_______________

60.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

61.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)
Version
7/
8/
04
10
SECTION
M
 
IMMUNE
SYSTEM
62.
Disease
[
]
Adult
[
]
Childhood
[
]
[
]
Lupus
[
]
Rheumatoid
Arthritis
[
]
Ulcerative
colitis
[
]
Optic
neuritis
[
]
Thyroid
cordiytis
[
]
other
__________________

63.
Stressors
[
]
(
Please
also
complete
table
in
Section
O.)

64.
Exposure
[
]
(
Please
also
complete
table
in
Section
P.)

SECTION
N
­
DEMOGRAPHICS
65.
Personal
Information
[
]
[
]
Age
[
]
Gender
[
]
Marital
Status
[
]
Race
[
]
Hispanic
[
]
non­
Hispanic
black
[
]
non­
Hispanic
white
[
]
Ancestry
[
]
Place
of
Birth
[
]
Citizenship
[
]
Year
of
Entry
[
]
Language
Spoken
at
Home
[
]
Disability
[
]
Grandparents
as
Caregivers
[
]
Other
____________________

66.
Income
and
Employment
[
]
[
]
Income
[
]
Labor
Force
Status
[
]
Industry
[
]
Occupation
[
]
Class
of
Worker
[
]
Work
Status
Last
Year
[
]
Veteran
Status
[
]
Other
______________________

67.
Transportation
[
]
[
]
Place
of
Work
[
]
Journey
to
Work
[
]
Vehicles
Available
[
]
Other
____________________

68.
Education
[
]
[
]
Enrollment
[
]
Attainment
[
]
Other
______________________

69.
Where
We
Live
[
]
[
]
Own
[
]
Rural
[
]
near
a
toxic
polluter
[
]
Rent
[
]
Suburban
[
]
other
_____________________
[
]
Residence
5
Years
Ago
[
]
Urban
Version
7/
8/
04
11
70.
Risk
factors
[
]
family
history
[
]
weakened
immune
system
[
]
social
factors
[
]
inherited
immune
deficiencies
[
]
dietary
factors
[
]
autoimmune
disease
[
]
obesity
[
]
HIV/
Aids
[
]
race
[
]
taking
immunosuppressant
drugs
[
]
gender
[
]
other
______________________
[
]
ethnicity
[
]
viruses
[
]
hygiene
[
]
Epstein
Barr
virus
[
]
age
[
]
HTLV­
1
[
]
income
level
[
]
Helicobacter
pylori
bacteria
[
]
central
city,
or
not,
or
not
in
MSA
[
]
Other
______________________
[
]
diet
[
]
pregnant
[
]
lactation
[
]
smoker
[
]
occupation
[
]
drug
user
[
]
alcohol
consumption
[
]
STDs
[
]
other
_________________________

SECTION
N
­
MISCELLANEOUS
71.
Early
Warning
Symptoms
[
]
Nausea
[
]
weakness
[
]
Dizziness
[
]
loss
of
vision
[
]
Headaches
[
]
Vomiting
[
]
diarrhea
[
]
Acute
Sensory
Irritation
[
]
weight
loss
[
]
salivation
[
]
tremors
[
]
other
__________________________

72.
Miscellaneous
[
]
mortality
[
]
morbidity
[
]
Body
burden
data
[
]
#
days
in
hospital
[
]
DALY
[
]
years
of
life
lost
[
]
life
expectancy
at
birth
[
]
infant
deaths
[
]
minor
restricted
activity
days
[
]
work
loss
days
[
]
school
loss
days
[
]
other
__________________

SECTION
O
 
STRESSORS
Please
complete
this
section
if
you
indicated
that
you
collect
data
on
stressors
in
Sections
D­
M.
Specify
the
number
of
the
applicable
question
and
the
body
system,
and
check
the
boxes
which
apply.

[
]
Criteria
Air
Pollutants
[
]
Metals
[
]
VOCs
[
]
ozone
[
]
lead
[
]
benzene
[
]
nitrogen
dioxide
[
]
arsenic
[
]
chloroform
[
]
carbon
monoxide
[
]
mercury
[
]
tetrachloroethylene
(
PERC)
[
]
sulfur
dioxide
[
]
cadmium
[
]
trichloroethylene
(
TCE)
[
]
lead
[
]
tungsten
[
]
toluene
[
]
particulate
matter
[
]
cobalt
[
]
styrene
[
]
nickel
[
]
other
_________________
[
]
chromium
[
]
other
________________
Version
7/
8/
04
12
[
]
Pesticides
[
]
Herbicides
[
]
Radiation
[
]
organochlorine
[
]
atrazine
[
]
Radon
[
]
DDT
[
]
alachlor
[
]
thoron
[
]
hexachlororcyclohexanes
[
]
radium
[
]
hexachlorobenzene
[
]
uranium
[
]
heptachlor
[
]
other
_____________
[
]
mirex
[
]
chlordane
[
]
pentachlorophenyl
[
]
organophsophate
[
]
malathion
[
]
parathion
[
]
methyl
parathion
[
]
triclopyr
[
]
chlopyrifos
[
]
chlorpyrifos
methyl
[
]
diazonon
[
]
kepone
[
]
dibromochloropropane
[
]
carbamate
[
]
POPs
[
]
dieldrin
[
]
heptachlor
[
]
hexachlorobenzene
[
]
mirex
[
]
adrin
[
]
endrin
[
]
dioxins
[
]
TCDD
(
agent
orange)
[
]
furans
[
]
toxaphene
[
]
disinfection
by
products
[
]
solvents
[
]
DES
[
]
PAHs
[
]
PCBs
[
]
aromatic
amines
[
]
vinyl
chloride
[
]
cotinine
[
]
asbestos
[
]
molds
[
]
animal
dander
[
]
pollen
[
]
dust
mites
&
cockroach
parts
[
]
tobacco
smoke
[
]
climate/
weather
[
]
other
______________
Version
7/
8/
04
13
SECTION
P
­
EXPOSURE
Please
complete
this
section
if
you
indicated
that
you
collect
data
on
stressors
in
Sections
D­
M.
Specify
the
number
of
the
applicable
question
and
the
body
system,
and
check
the
boxes
which
apply.

[
]
Occupational
[
]
Recreational
[
]
Residential
[
]
Disaster/
Emergency
Incident
[
]
Other
_____________________

[
]
ingestion
[
]
food
[
]
seafood
[
]
meat
[
]
poultry
[
]
produce
[
]
milk/
dairy
products
[
]
cereal/
grain
[
]
paint
chips
[
]
other
____________
[
]
water
[
]
soil
[
]
inhalation
[
]
paint
fumes
[
]
volcanoes
[
]
coal
burning
[
]
incinerators
[
]
residential
&
industrial
furnaces
[
]
tobacco
smoke
[
]
pulp
&
paper
mills
[
]
dust
[
]
motor
vehicle
exhaust
[
]
mining
&
smelting
[
]
pesticides
during
application
[
]
construction
(
asbestos,
etc.)
[
]
Other
__________________________

[
]
dermal
contact
[
]
animal
bite
[
]
insect
bite
[
]
mining
&
smelting
[
]
sun
[
]
contact
with
water
[
]
pitch
&
tar
[
]
Other
____________________

[
]
human­
to­
human
[
]
blood
[
]
feces
[
]
sputum
[
]
other
_________________________

73.
Comment
Field
(
Please
explain
any
responses
requiring
clarification.)

74.
Please
attach
a
bibliography
of
products
that
have
resulted
from
this
data
collection
program.
Include
reports,
books,
journal
articles,
etc.

75.
Please
provide
a
point
of
contact
for
obtaining
GIS
coverage
or
lat/
longs
of
data
collection
sites.
Name:
______________________________________
Phone
#:
____________________________________
E­
mail:
_____________________________________

(
This
information
is
needed
to
complete
the
geo­
referenced
database.)
Version
7/
8/
04
14
76.
Please
provide
your
website
URL
(
if
available):
http://
______________________________________

77.
Please
indicate
who
completed
this
form.
Name:
______________________________________
Phone
#:
____________________________________
E­
mail:
_____________________________________

(
This
will
help
us
if
we
have
any
questions
about
your
information.)

78.
We
have
sent
this
inventory
form
to
major
federal
and
state
environmental
organizations.
Are
there
any
other
agencies/
institutions
that
conduct
environmental
public
health
monitoring
programs
that
should
be
included
in
our
inventory?
Please
specify
and
provide
a
point
of
contact
(
name
&
phone
#).

Not
sure
what
to
do
with
these:
Chicken
pox
Measles
Cancer
Smallpox
Anthrax
Plague
Hemorrhagic
fever
(
Ebola)
Break­
bone
fever
West
Nile
virus
Hanta
virus
Streptococcus
pyogenes
(
Group
A
streptococcus)
(
flesh­
eating
bacteria)
Anti­
biotic
resistant
bacteria
Pfiesteria
Biological
warfare
agents