| Present decibel level: |
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| Desired decibel level: |
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| Note: |
10 decibels is about 1/2 as loud. 5 decibels is about 1/4 as loud and noticeable |
| What regulatons pertain: |
OSHA |
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City |
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State |
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Property line |
| What is the noise source: |
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| Make/Model: |
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| Can the equipment be enclosed: |
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| Air flow or space requirements: |
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| How often is access required: |
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| Door or window needed: |
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| Are there surfaces that reflect the noise: |
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| Distance and relationship: |
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| Special requirements or limitations: |
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| Note: |
Please include a sketch with distances noted if possible. |
| Business/Org. Name: |
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| Contact Name: |
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| Phone #: |
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| Fax: |
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| Email: |
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