This document contains a table for calculating ambient air quality levels based on field measurements for an environmental impact assessment of air pollution. It lists parameters like PM10, SO2, CO, O3, and NO2 along with their standard pollution indices and measured values. The table requires entering primary data from field treatment into columns B through F. It is dedicated to the author's wife and daughters, as well as environmental agencies and people of Samosir Regency, and alumni of a university program.