ATTACHMENT 1 20B0014 FHTX 25 JUNE 2020.pdf

SECTION 1 - GENERAL

SECTION 2 – NEC

SECTION 3 – AW

D P

W M

A

IN

T E

N A

N C

E S

H O

P

M a ke M o de l N u m be r S e ri al N u m b e r R ef ri g e ra n t T yp e

C om p re ss o r S e ri al N u m b e r L o ca tio n o f L e a k o n E q ui p m e n t M a ke

U ni t R e fr ig er a n t C h a rg e r

C ir cu it

M o de l N u m be r R ef ri g e ra n t R e co ve re d lb s.

oz r

C ir cu it

S e ri al N u m b e r R ef ri g e ra n t A d d ed lb s.

o z) r C irc u it

R ef ri g e ra n t

T yp e V a cu u m

L e ve l A ch ie ve d in ch e s H g

V a cu u m L e ve l A ch ie ve d in ch e s

H g

*N et L e a ka g e lb s.

o z)

R ef ri g e ra n t

A d d ed lb s.

o

z) *N et L e a ka g e r e fr ig er a n t a d d e d r ef ri g e ra n t re co ve re d a cc id e n ta l l o ss

R ef ri g e ra n t

R e m o ve d lb s.

o

z) N ot e s:

M a ke M e th o d u se d f or v e ri fic a tio n

M o de l N u m be r

L e a k re p a ir ed Y e s

N o S e ri al N u m b e r If n o, a ct io n ta ke n R ef ri g e ra n t T yp e

R ef ri g e ra n t

A d d ed lb s.

o

z) M e th o d u se d f or v e ri fic a tio n

R ef ri g e ra n t

R e m o ve d lb s.

o

z) L e a k re p a ir ed

Y e s

N o lb s.

o

z) If n o, a ct io n ta ke n (T e ch w ill a d vi se

R e a l P ro p e rt

y) R ef ri g e ra n t C h a rg e p e r C ir cu it

N ot e s:

S ig n a tu re o f

C e rt ifi e d

T e ch n ic ia n T ur n or D at e

R /M

H /D

Y

T yp e

C he ck Y

R

C yl

S er ia l #

P ri n t N a m e (E

C O

S ig n a tu re

E C

O

V irg in /R ec yc le d

/R ec ov er ed

V irg in /R ec yc le d

/R ec ov er ed

V irg in /R ec yc le d

/R ec ov er ed

V irg in /R ec yc le d

/R ec ov er ed

Form Approved OMB No. 2060-0256

EPA regulations require establishments that service or dispose of refrigeration or air-conditioning equipment to certify that they have acquired recovery or recycling devices that meet EPA standards for such devices. To certify that you have acquired equipment, please complete this form according to the instructions and

Name of Establishment Street

(Area Code) Telephone Number City State Zip Code

Number of Service Vehicles Based at Establishment County

Identify the type of work performed by the establishment

Type A - Service small appliances Type B - Service refrigeration or air-conditioning equipment other that small appliances Type C- Dispose of small appliances Type D - Dispose of refrigeration or air-conditioning equipment other than small appliances

Name of Device(s) Manufacturer Model Number Year Serial Number (if any) Check Box if Self-Contained 1.

2.

3.

4.

5.

I certify that the establishment in Part 1 has acquired the refrigerant recovery or recycling device(s) listed in Part 2, that the establishment is complying with Section 608 regulations, and that the information gives is true and correct.

Signature of Owner/Responsible Officer Date Name (Please Print) Title

INSTRUCTIONS

Please provide the name, address, and telephone number of the establishment where the refrigerant recovery or recycling device(s) is (are) located. Please complete one form for each location.

State the number of vehicles based at this location that are used to transport technicians and equipment to and from service sites.

Check the appropriate boxes for the type of work performed by technicians who are employees of the establishment. The term “small appliance” refers to any of the following products tat are fully manufactured, charged, and hermetically sealed in a factory with five pounds or less of refrigerant:

refrigerators, and freezers designed for home use, room air conditioners (including window air conditioners and packaged terminal air conditioners), packaged terminal heat pumps, dehumidifiers, under-the-counter ice makers, vending machines, and drinking water coolers.

For each recovery or recycling device acquired, please list the name of the manufacturer of the device, and (if applicable) its model number and serial number.

If more that seven devices have been acquired, please fill out an additional form and attach it to this one. Recovery devices that are self-contained should be listed first and should be identified by checking the box in the last column on the right. Self-contained recovery equipment means refrigerant recovery or recycling equipment that is capable of removing te refrigerant from an appliance without the assistance of components contained in the appliance. On the other hand, system-dependent recovery equipment means refrigerant recovery equipment that requires the assistance of components contained in an appliance to remove the refrigerant from the appliance.

If the establishment has been listed as Type B and/or Type D in Part 2, then the first device listed in Part # must be a self-contained device and identifies as such by checking the box in the last column on the right.

If any of the devices are homemade, they should be identified by writing “homemade” in the column provided for listing the name of the device manufacturer. Type A or Type B establishments can use homemade devices manufactured before November 15, 1993. Type C or Type D establishments can use homemade manufactured anytime. If, however, a Type C or Type D establishment is using homemade equipment manufactured after November 15, 1993, then it must not use these devices for service jobs.

Send your form to the EPA office listed under the state or territory in which the establishment is located.

Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

CAA 608 Enforcement Contact: EPA Region I; Mail Code SEA; JFK Federal Building; One Congress Street, Suite 1100; Boston, MA 02114-2023

Arkansas, Louisiana, New Mexico, Oklahoma, Texas

CAA 608 Enforcement Contact: EPA Region VI; Mail Code 6EN-AA; 1445 Ross Ave., Suite 1200; Dallas, TX 75202

New York, New Jersey, Puerto Rico, Virgin Islands

CAA 608 Enforcement Contact: EPA Region II; Mail Code 2DECA-AC; 290 Broadway; New York, NY 10007-1866

Iowa, Kansas, Missouri, Nebraska

CAA 608 Enforcement Contact: EPA Region VII; Mail Code APCOARTD; 901 North Fifth Street; Kansas City, KS 66101

Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia

CAA 608 Enforcement Contact: EPA Region III-Wheeling Office; Mail Code 3AP12; 303 Methodist Building; 11th and Chapline Streets; Wheeling, WV 26003

Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

CAA 608 Enforcement Contact: EPA Region VIII; Mail Code 8ENF-T; 999 18th

Street, Suite 500; Denver, CO 80202

Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

CAA 608 Enforcement Contact: EPA Region IV; Mail Code APT-AE; 61 Forsyth Street, SW; Atlanta, GA 30303-8960

American Samoa, Arizona, California, Guam, Hawaii, Nevada

CAA 608 Enforcement Contact: EPA Region IX; Mail Code AIR-5; 75 Hawthorne Street; San Francisco, CA 94105

Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin

CAA 608 Enforcement Contact: EPA Region V; Mail Code AE-17J; 77 West Jackson Blvd.; Chicago, IL 60604

Alaska, Idaho, Oregon, Washington

CAA 608 Enforcement Contact: EPA Region X; Mail Code OAQ-107; 1200 Sixth Ave.; Seattle, WA 98101

Proposed Project Emissions Inventory Questionnaire for New Sources

The Decision Support System provides several documents linked together to aid in the Title V application and review process. These documents include Rule Text, Relationship Entry Screens, Flowcharts and Historic Rule Opinions (when applicable). Most of these documents and their subparts are available in Portable Document Format(PDF). To view the documents in this format, a free copy of Adobe Acrobat Reader will have to be installed on your computer. For best results, install the most current version of Adobe Reader.

Guidance for using the Decision Support System

40 CFR Part 59 - National Volatile Organic Compound Emission Standards for Consumer and Commercial Products 40 CFR Part 60 - Standard of Performance for New Stationary Sources(NSPS) 40 CFR Part 61 - National Emission Standards for Hazardous Air Pollutants (NESHAPS) 40 CFR Part 63 - National Emission Standards for Hazardous Air Pollutants for Source Categories(a.k.a. Maximum Achievable Control Technology (MACT)) 40 CFR Part 82 - Protection of Stratospheric Ozone 30 TAC Chapters 39, 101-122 - Control of Air Pollution

Applicability Determination Index (ADI)

The EPA also has a database available online that contains memoranda issued by the the agency on applicability and compliance issues associated with NSPS, NESHAP and MACT Standards

Requestor: ____________________________ Date: _____________ Phone: _____________ Project # _____________________________ Facility Name / Building Number: ____________________________ Descriptive Name of Facility: ______________________________________________ Location of Facility: UTM Zone: 14 Horizontal Coordinate _____________________E Vertical Coordinate ____________________N

Indicate proposed emission source type and complete all applicable fields for each process.

Complete questionnaire sheet for each process type in this facility.

INTERNAL COMBUSTION UNITS (I.E. GENERATORS, ENGINE TEST CELLS)

(Covered by 30 TAC 106.511 and 30 TAC 106.261)

Make_________________ Model_____________ Serial #________________ Power Rating: ____kw; Horsepower: ___ HP Fuel Type: ________________ MUR/JP8/Diesel; Integrated Fuel Tank Capacity: __________gallons Make_________________ Model_____________ Serial #________________ Power Rating: ____kw; Horsepower: ___ HP Fuel Type: ________________ MUR/JP8/Diesel; Integrated Fuel Tank Capacity: __________gallons Make_________________ Model_____________ Serial #________________ Power Rating: ____kw; Horsepower: ___ HP Fuel Type: ________________ MUR/JP8/Diesel; Integrated Fuel Tank Capacity: __________gallons Make_________________ Model_____________ Serial #________________ Power Rating: ____kw; Horsepower: ___ HP Fuel Type: ________________ MUR/JP8/Diesel; Integrated Fuel Tank Capacity: __________gallons Make_________________ Model_____________ Serial #________________ Power Rating: ____kw; Horsepower: ___ HP Fuel Type: ________________ MUR/JP8/Diesel; Integrated Fuel Tank Capacity: __________gallons

Separate Fuel Tank(s): YES / NO (circle one) Complete Separate Questionnaire for Each Tank Seasonal Operating Percentage for This Emission Point:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____ hours/day _____days/week _____ weeks/year____ Normal Operating Rate: _______________gallons or CuFt/ year

FUEL STORAGE TANKS (Covered by 30 TAC 115.473 , 30 TAC 106.478 and 30 TAC Chap 115)

Make__________________Model_________________Serial #______________ Fuel Type: _____________ Tank Volume: __________gals;Tank Dimensions (ft): Diameter _______Length_______ Height________ Make__________________Model_________________Serial #______________ Fuel Type: _____________ Tank Volume: __________gals;Tank Dimensions (ft): Diameter _______Length_______ Height________ Make__________________Model_________________Serial #______________ Fuel Type: _____________ Tank Volume: __________gals;Tank Dimensions (ft): Diameter _______Length_______ Height________ Make__________________Model_________________Serial #______________ Fuel Type: _____________ Tank Volume: __________gals;Tank Dimensions (ft): Diameter _______Length_______ Height________ Make__________________Model_________________Serial #______________ Fuel Type: _____________ Tank Volume: __________gals;Tank Dimensions (ft): Diameter _______Length_______ Height________

Tank Type: Aboveground / Underground (circle one); Vapor Control Equipped: YES / NO (circle one) Roof Type: Horizontal Fixed Roof / Vertical Fixed Roof / Internal Floating Roof / Pressure Tank External Floating Roof

Seasonal Operating Percentage for This Emission Point:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____hours/day _____days/week _____weeks/year_____ Normal Operating Rate: _______________gallons/year Maximum Operating Rate: _______________gallons/hour

EXTERNAL COMBUSTION UNITS (Boilers, Hot Water Heaters, Process Heaters) (Covered by 30 TAC 106.102 and 30 TAC 106.183) Fuel Type: Natural Gas / Diesel Make__________________Model_________________Serial #___________________ Input Rating: __________ MMBTUH Height of Stack: __________ ft ; Diameter of Stack: __________ ft; Stack Exhaust Velocity: ______________ft / sec Make__________________Model_________________Serial #___________________ Input Rating: __________ MMBTUH Height of Stack: __________ ft ; Diameter of Stack: __________ ft; Stack Exhaust Velocity: ______________ft / sec Make__________________Model_________________Serial #___________________ Input Rating: __________ MMBTUH Height of Stack: __________ ft ; Diameter of Stack: __________ ft; Stack Exhaust Velocity: ______________ft / sec Make__________________Model_________________Serial #___________________ Input Rating: __________ MMBTUH Height of Stack: __________ ft ; Diameter of Stack: __________ ft; Stack Exhaust Velocity: ______________ft / sec

Seasonal Operating Percentage for These Emission Points:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____ hours/day _____days/week _____ weeks/year____ Normal Operating Rate:

_______________gallons/year

FUEL DISPENSING UNITS (Covered by 30 TAC 106.412) Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________

Fuel Type: MUR / Diesel / JP-8 / Other ______________ (circle one) Dispensing Type: Retail / Bulk (circle one) Vapor Control Equipped : YES / NO (circle one) Dispenser Pump rate: __________ gallons/minute Seasonal Operating Percentage for This Emission Point:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____ hours/day _____days/week _____ weeks/year____ Normal Operating Rate: _______________gallons/year

SURFACE COATING OPERATIONS (Covered by 30 TAC 106.433 , 30 TAC 106.436 or 30 TAC 116.110)

Attach approved MSDS of each coating and solvent used in process Particulate Matter Control Efficiency of Booth: __________% Booth Air Flow Rate:___________scfm Transfer Efficiency of Paint Gun: __________% Number of Paint Guns: __________ Associated Heater: YES / NO (circle one) Complete Separate Questionnaire for Each Heater Associated Gun Cleaner: YES / NO (circle one) Complete Separate Questionnaire for Each Cleaner Seasonal Operating Percentage for This Emission Point:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____hours/day _____days/week _____weeks/year____ Normal Operating Rate: _______________gallons/year (each coating and solvent)

REFRIGERATION EQUIPMENT (AIR CONDITIONING SYSTEM, FREEZER) (Covered by 30 TAC 106.103)

Make__________________ Model____________Serial#___________________ No. of compressors: ______ Refrigerant Type: __________ Amount of Charge:______lbs; Initial Charge Date:_____/_____/_____ Make__________________ Model____________Serial#___________________ No. of compressors: ______ Refrigerant Type: __________ Amount of Charge:______lbs; Initial Charge Date:_____/_____/_____ Make__________________ Model____________Serial#___________________ No. of compressors: ______ Refrigerant Type: __________ Amount of Charge:______lbs; Initial Charge Date:_____/_____/_____ Make__________________ Model____________Serial#___________________ No. of compressors: ______ Refrigerant Type: __________ Amount of Charge:______lbs; Initial Charge Date:_____/_____/_____ Make__________________ Model____________Serial#___________________ No. of compressors: ______ Refrigerant Type: __________ Amount of Charge:______lbs; Initial Charge Date:_____/_____/_____

Seasonal Operating Percentage for This Emission Point:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____hours/day _____days/week _____weeks/year_____

WELDING OPERATIONS (Covered by 30 TAC 106.227)

Attach approved MSDS of each welding rod type used in process Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________

Particulate Matter Control Efficiency of hood (if available): __________% Exhaust Fan Ventilation Rate :___________scfm Acetylene on hand: __________lbs of gas Oxygen on hand: __________ lbs of gas Seasonal Operating Percentage for This Emission Point:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____hours/day _____days/week _____weeks/year____ Normal Operating Rate: _______________# of rods/year

BRAKE REPAIR OPERATIONS (Covered by 30 TAC 106.261 and 30 TAC 106.262)

Attach approved MSDS of each brake pad type used in process Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________ Make__________________Model_________________Serial #___________________

Particulate Matter Control Efficiency of hood (if available): 1st Stage ________%; 2nd Stage_____% Exhaust Fan Ventilation Rate :___________scfm Seasonal Operating Percentage for This Emission Point:

Spring _____% Summer _____% Fall _____% Winter _____% Note: Total Must Equal 100% Normal Operating Schedule: Start Time_____hours/day _____days/week _____weeks/year____ Normal Operating Rate: _______________# of Brakes Repaired/year

ENV Use Only FIN, EPN and CIN determination comes from Emissions Inventory Guidelines

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN # _________________ EPN #_________________ CIN #__________________

FIN- Facility Identification Number; EPN- Emission Point Number; CIN- Control Identification Number

ENV Use Only Received on __________ for submittal in _________ Permit

AUTHORIZATION TO PROCEED WITH CHANGE

Authorized by: ____________________ Title: ______________________ Signature: ________________________ Date: ______________________

AUTHORIZATION FOR STARTUP

Authorized by: ____________________ Title: ______________________

Proposed Project Emissions Inventory Questionnaire for New Sources

PRIME COMPANY NAME: _______________________________ CONTRACT NO: _______________________

PROJECT TITLE/LOCATION: ___________________________________________________________________

*Contractor(s) certifies that the hazardous material(s) removed from installation will be used/reused for its intended purpose.

Submitted By: Phone: Fax:_______ Date:

Printed Name

Contracting Officer Phone: Fax:_______ or Representative Page____of____

Company Using Material Listed Above Company Representative's Signature

PRIME COMPANY NAME: _______________________________ CONTRACT NO: _______________________

PROJECT TITLE/LOCATION: ___________________________________________________________________

Page____of____

Continuation Sheet

LANDFILL PERMIT

DPW COR POC and telephone phone number: _______________________________________ Contract Name: ________________________________________________________________ Contract Number: _______________________________________________________________ Contract completion date or end of authorization date: __________________________________ Building or areas affected (i.e., Soldier's Development Center):

Prime Contractor's Name: ________________________________________________________ Contractor POC and phone (i.e. someone on site that can get immediate action):

Appendix D: Customer Service Inspection Certificate (30 TAC §290.47(d))

DIVING

b. AGE c. SEX e. GRADE

a. DATE OF ACCIDENT

(month/day/year)

(1) PRIME:

PRIMARY

(CODE) (CODE)

(CODE)

c. SEAT BELTS USED NOT USED NOT AVAILABLE

(1) FRONT SEAT

(2) REAR SEAT

b. ESTIMATED DAYS LOST c. ESTIMATED DAYS

HOSPITALIZED

d. ESTIMATED DAYS

REST. DUTY

a. SEVERITY OF ILLNESS/INJURY (CODE)

(For Safety Staff only)

REPORT

NO.

EROC

CODE

PERSONNEL CLASSIFICATION INJURY/ILLNESS/FATAL PROPERTY DAMAGE MOTOR VEHICLE INVOLVED

GOVERNMENT

a. NAME (Last, First, MI) d. SOCIAL SECURITY NUMBER

f. JOB SERIES/TITLE g. DUTY STATUS h. EMPLOYMENT STATUS AT TIME OF ACCIDENT

b. TIME OF ACCIDENT c. EXACT LOCATION OF ACCIDENT d. CONTRACTOR'S NAME (military time) hrs

(2) SUBCONTRACTOR

e. CONTRACT NUMBER f. TYPE OF CONTRACT g. HAZARDOUS/TOXIC WASTE

e. BODY PART AFFECTED (CODE) g. TYPE AND SOURCE OF INJURY/ILLNESS

(Fill in line and corresponding code number in box from list - see instructions)

a. CONSTRUCTION ACTIVITY (CODE) b. TYPE OF CONSTRUCTION EQUIPMENT (CODE)

(Include name on line and corresponding code number in box for items e, f & g - see instructions)

a. ACTIVITY AT TIME OF ACCIDENT (CODE) b. PERSONAL FLOATATION DEVICE USED?

(Fill in line and correspondence code number in box - see instructions)

(2) (3)

b. TYPE OF COLLISIONa. TYPE OF VEHICLE

a. NAME OF ITEM b. OWNERSHIP c. $ AMOUNT OF DAMAGE (1)

f. NATURE OF ILLNESS/INJURY (CODE)

a. TYPE OF VESSEL/FLOATING PLANT (CODE) b. TYPE OF COLLISION/MISHAP (CODE) (Fill in line and correspondence code number in box from list - see instructions)

CIVILIAN MILITARY

CONTRACTOR

PUBLIC FATAL OTHER

FIRE INVOLVED OTHER

FIRE INVOLVED OTHEROTHER

MALE FEMALE

ARMY ACTIVE

PERMANENT

TEMPORARY

OTHER (Specify)

ARMY RESERVE

FOREIGN NATIONAL

STUDENT

VOLUNTEER

SEASONAL

ON DUTY TDY

OFF DUTY

CIVIL WORKS

OTHER (SPECIFY)

MILITARY

CONSTRUCTION SERVICE

A/E DREDGE

OTHER (SPECIFY)____________

SUPERFUND

IRP

DERP

OTHER (SPECIFY)

# YES NO N/A

PICKUP/VAN

TRUCK

AUTOMOBILE

OTHER (Specify)

SIDE SWIPE

BROADSIDE

OTHER (Specify)

HEAD ON

ROLL OVER

REAR END

BACKING

YES NO a. (CONTINUED) YES NO

Month/Day/Year

a. DIRECT CAUSE

b. INDIRECT CAUSE(S)

DESCRIBE FULLY:

f. OFFICE SYMBOL

CORPS

CONTRACTOR

a. b. c. COMMENTS

SIGNATURE TITLE DATE

a. b. c. COMMENTS

SIGNATURE TITLE DATE

a. b.

SIGNATURE TITLE DATE

See attached page.

a. BEGINNING (Month/Day/Year) b. ANTICIPATED COMPLETION (Month/Day/Year)

COMMANDER SIGNATURE DATE

c. ADDITIONAL ACTIONS/COMMENTS

c. SIGNATURE AND TITLE OF SUPERVISOR d. DATE (Month/Day/Year) e. ORGANIZATION IDENTIFIER (Div,Br,Sect) maintenance of personal protective eqpt contribute to the accident?

contribute to the accident?

b. WAS A WRITTEN JOB/ACTIVITY HAZARD ANALYSIS

HUIMAN FACTORS: Did any human factors such as size or strength of accident?

DRUGS/ALCOHOL: In your opinion, was deugs or alcohol factor to the person, etc., contribute to accident?

ENVIRONMENTAL FACTORS: Did heat, cold, dust, sun, glare, etc.

condition of the person a factor?

exposure to chemical agents, such as dust, fumes, mists, vapors, or

INSPECTION/MAINTENANCE: Were inspection & maintenance procedures a factor?

PERSON'S PHYSICAL CONDITION: In your opinion, was the physical

OFFICE FACTORS: Did office setting such as, lifting office furniture, physical agents such as noice, radiation, etc. contribute to accident?

carrying, stooping, etc. contribute to the accident?

(Read Instructions Before Completing)

a. (Explain YES answers in item 13 DESIGN: Was design of facility, workplace or equipment a factor?

CHEMICAL AND PHYSICAL AGENT FACTORS: Did

SUPPORT FACTORS: Were inappropriate tools/resources provided

See attached page.

OPERATING PROCEDURES: Were operating procedures a factor?

JOB PRACTICES: Were any job safety/health practices not followed when the accident occurred?

to properly perform the activity/task?

PERSONAL PROTECTIVE EQPT: Did the improper selection, use or

a. WAS PERSON TRAINED TO PERFORM ACTIVITY/TASK? c. DATE OF MOST RECENT FORMAL TRAINING

See attached page.

COMMENTS

COMPLETED FOR TASK BEING PERFORMED AT TIME OF

ACCIDENT?

b. TYPE OF TRAINING

NO

YES NO

CONCUR NON CONCUR

CONCUR NON CONCUR

CONCUR NON CONCUR

YES (If yes, attach a copy)

CLASSROOM ON JOB

10. ACCIDENT DESCRIPTION (Continuation)

Sample of typical Contractor Quality Control Report

PREPARATORY PHASE CHECKLIST

Task Order Number _________________ Date:_____________________ Definable Feature:_______________ Spec Section:_______________ Gov't Rep Notified ________ Hours in Advance Yes________ No_______ I. Personnel Present:

Name Position Company/Government 1.____________________________________________________________________________ 2.____________________________________________________________________________ 3.____________________________________________________________________________ 4.____________________________________________________________________________ 5.____________________________________________________________________________ 6.____________________________________________________________________________ 7.____________________________________________________________________________ 8.____________________________________________________________________________ 9.____________________________________________________________________________ 10.___________________________________________________________________________ (List additional personnel on reverse side)

II. Submittals

1. Review submittals and submittal register.

Have all submittals been approved? Yes_________ No_________ If no, what items have not been submitted?

a.____________________________________________________________________________ b.____________________________________________________________________________ c.____________________________________________________________________________

2. Are all materials on hand? Yes_________ No__________ If no, what items are missing?

a.____________________________________________________________________________ b.____________________________________________________________________________ c.____________________________________________________________________________

3. Check approved submittals against delivered materials. (This should be done as material arrives.)

Comments_____________________________________________________________________

III. Material storage

Are materials stored properly? Yes___________ No ____________ If No, what action is taken?_______________________________________________________

IV. Specifications

1. Review each paragraph of specifications.

2. Discuss procedure for accomplishing the work.

3. Clarify any differences.

V. Preliminary Work and Permits nsure preliminary work is correct and permits are on file. f not, what action is taken?

VI. Testing

1. Identify test to be performed, frequency, and by whom

2. When required?

3. Where required?______________________________________________________________________

4. Reviewing Testing Plan._________________________________________________________________________

5. Have test facilities been approved?_____________________________________________________________________

VII. Safety

1. Review applicable portion of EM 385-1- 1.____________________________________________________________________________ ____________________________________________________2. Activity Hazard Analysis approved? Yes ________ No ________

VIII. DPW comments during meeting.

CQC REP

INITIAL PHASE CHECKLIST

Task Order Number_________________ Date:_____________________ Definable Feature:_______________ Gov't Rep Notified ________ Hours in Advance Yes________ No_______

I. Personnel Present:

Name Position Company/Government 1.____________________________________________________________________________ 2.____________________________________________________________________________ 3.____________________________________________________________________________ 4.____________________________________________________________________________ 5.____________________________________________________________________________ 6.____________________________________________________________________________ 7.____________________________________________________________________________ 8.____________________________________________________________________________ 9.____________________________________________________________________________ 10.___________________________________________________________________________ (List additional personnel on reverse side)

II. Identify full compliance with procedures identified at preparatory. Coordinate plans, specifications, and submittals.

Comments

III. Preliminary Work. Ensure preliminary work is complete and correct. If not, what action is taken?

IV. Establish Level of Workmanship.

1. Where is work located?

2. Is a sample panel required? Yes ______ No ______

3. Will the initial work be considered as a sample? Yes _________ No _____________

(If yes, maintain in present condition as long as possible.)

V. Resolve any differences.

Comments

VI. Check Safety Review job conditions using EM 385-1-1 and job hazard analysis. Comments

CQC REP

OPERATION AND MAINTENANCE INSTRUCTIONS

STANDING OPERATING Directorate of Public Works PROCEDURE III Corps and Fort Hood, TX NO. MNT Fort Hood, TX 76544-5028

- 1 -

TAB C

PROCEDURE FOR INSTALLATION OF ELECTRONIC LOCKS

UTILIZING PLASTIC CARD KEYS

23 JUL 2015

PURPOSE: To outline the procedure to perform all installation of locking devices or duplicating, fabrication and issue of associated keys. The SOP applies for all types of Plastic card key locking systems used on Fort Hood Real Property facilities.

OBJECTIVE: To provide a simplified procedure to facilitate Plastic card key and electronic lock control at Fort Hood.

1. RESPONSIBILITIES:

a. Existing Facilities.

(1) Contractors, DPW personnel, and Corps of Engineers personnel will provide electronic locking devices SAFLOK model number 6000, or Stanley/Best series BASIS G, including Handheld Lock Programmer/Interrogator/Lab Top/Diagnostics Unit utilized by the system to operate exterior locks for all doors. Project lead will provide one (1) insertion encoder and all necessary software, approved by IASO. A two (2) year warranty will be provided on the system and all components and locksets, which will be of grade 1 quality approved by DPW, PPD that match the locking system and hardware in existing facilities.

(2) For contract orders, metal override keys will be supplied on all the locking systems for a facility. For marking the override keys, facility codes are to be obtained from Lock shop area by the COR in a written (email) request. 3 metal override keys per room – 2 facility manager keys and 1 DPW board key – are to be provided, unless otherwise designated.

(3) On existing facilities the contractor will provide blank key cards as follows:

a.) 100 locks or more - provide 2,000 blank key cards b.) 25 to 99 locks - provide 500 blank key cards c.) less than 25 locks - proved 100 blank key cards

(4) On existing facilities with SAFLOK - key cards have smart chip On existing facilities with BASIS G - key cards have magnetic strip

(5) Preventive maintenance will be performed by DPW Real Property as necessary.

(6). The project COR will be responsible for turning in all card keys/override keys, key

NO. MNT Fort Hood, TX 76544-5028

- 2 -

TAB C

Schedule, bitting codes with room number/location next to the bitting code, and 500 unused bitting codes to DPW Real Property before final payment is made to the contractor. Real Property will forward blank card keys over to Housing project manager to be issued to the Barracks managers. Bitting codes obtained from the manufacturer will be sent via Registered Mail for control/tracking purposes.

(7). Key designation shall be legible by eye, per paragraph 2, below.

b. New Facilities.

(1). Contractors, DPW personnel, and Corps of Engineers personnel will provide electronic locking devices by Stanley/Best, series BASIS G, in addition, provide handheld Lab Top/Diagnostics Unit to operate exterior locks for all doors. Project lead will ensure 10% extra locksets are provide as spares, and one (1) encoding station and all necessary software/licenses are approved by IASO. A Stanley/Best representative shall install the system, program all locksets, and make and label all keys so that this is a turnkey project. In addition, the representative shall provide two (2) separate 4-hour classes of training (to include training manuals) for all users to operate card encoding stations.

(2) A preconstruction meeting of contractors, DPW, Corps of Engineers and DPW Lock Shop personnel shall determine how locks shall be keyed or programed in sets or subsets as scheduled. Locks shall be furnished with the manufacturers’ standard construction key system. Patented cores will not be used for any locks.

(3). For new facilities the contractor shall provide a complete master keyed locking system with metal override keys. Facility codes are to be obtained from DPW Lock shop by the COR in a written (email) request. 3 keys per room – 2 facility manager keys and 1 DPW board key – are to be provided, unless otherwise designated.

(4). The contractor/COR shall maintain secure key control of all facilities until turned over to Real Property.

(5). Floor plans with room numbers shall be provided by the contractor to the COR/Real Property located in building 4622.

(6). The card keys/hard keys and floor plans are to be provided to Real Property 5 (five) days prior to the day the facility is turned over to DPW.

(7). The project COR will be responsible for turning in all card keys/override keys, key schedule, bitting codes with room number/location next to the bitting code, and 500 unused bitting codes to DPW Real Property before final payment is made to the contractor. Real property will forward blank card keys over to Housing project manager to be issued to the barracks managers. Bitting codes obtained from the manufacturer will be sent via Registered Mail for control/tracking purposes.

NO. MNT Fort Hood, TX 76544-5028

- 3 -

TAB C

(8). Key designation shall be legible by eye, per paragraph 2, below.

2. MARKING:

A. Metal Override Keys will be marked as follows:

(1). Keys will be stamped “US Government do not duplicate” On one side and will have the facility code and room number/location stamped on the opposite side of the key, or facility number and room number as required in para 1, a, (2) above.

(2). Key codes to be obtained from DPW Lock shop by the COR in a written (email) request.

(3). Key markings will be between 1/16 inch and 1/8 inch and be legible to the eye.

3. This SOP supersedes all previous versions.

BRIAN DOSA

Director of Public Works

DISTRIBUTION:

All DPW Divisions

Network Enterprise Center

Information Infrastructure Installation Guidelines

NEC INFORMATION INFRASTRUCTURE INSTALLATION GUIDELINES

Information Infrastructure Installation Guidelines

FEBRUARY 2013

NETWORK ENTERPRISE CENTER

February 2013 Page 2 of 67

Distribution Distribution authorized to U.S. Government agencies and their contractors only, for administrative or operational use, February 2013. Refer other requests for this document to Network Enterprise Center, ATTN: NEC, Plans Branch, Fort Hood, TX 76749

FOREWORD

Approval of this Standard

This standard is written and approved by the Director, Network Enterprise Center, Fort Hood, Texas.

Be advised that due to rapidly changing technologies, Fort Hood, NEC anticipates change out of copper to fiber as unified communications (VOIP), is planned for.

Documents Superseded

This guideline replaces Network Enterprise Center, Installation Infrastructure Installation Design Guidelines, dated October 2009 in its entirety.

Significant Administration and Technical Changes from the Previous Edition

All previous technical changes have been incorporated into this document.

February 2013 Page 3 of 67

TABLE OF CONTENTS KW

FOREWORD

CHAPTER 1 INTRODUCT .7

2. ..7

3. 8

4. Overview of this manual

CHAPTER 2 THE HORIZONTAL 1

1. 1

2. The Type and Number for Modular T 1

3. Cable Types and Length 4

4. 5

5. Termination Hardware Requirements at the B 6

6. Assigning Identifying Numbering for Outlet and B 8

7. Cross Connecting Voice and Data O 21

8. Structures to Support the Horizonta 1

9. . 2

CHAPTER 3 THE EQUIPMENT AND TEL 7

1. 7

2. 7

4. Location of the Equipment/Telecommunications Room 7

5. 28

6. 30

7. 32

February 2013 Page 4 of 67

CHAPTER 4 THE BUILDING 4

1. 4

2. Termination Hardware Require 4

3. Structures to Support the Cab 5

4. CAD Drawings for Construction/ 5

1. The 7

2. Size, Type and Termination of Copper Ris 7

3. Size, Type and Termination of Fiber Optic 8

4. Testing Requirements for Copper and Fiber Optic 8

5. Structures to Support Vertically Aligned Intermediate 8

6. Structures to Support Horizontally Aligned Intermediate 8

CHAPTER 6 THE OUTSIDE PLANT SE 40

1. 40

2. 40

3. Cable Distribution Metho 40

4. 41

5. 42

6. Maintenance Manholes/Hand 3

7. Aerial Cable Requirements 5

8. 45

9. Building Entrance Terminals 8

10. Electrical Protection and Bonding/Groundin 8

11. Testing Requirements for Outside Plant Fiber a 8

12. Labeling Requirements 50

..54

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February 2013 Page 6 of 67

CHAPTER 1 INTRODUCTION

1. About This Manual

a. This manual contains the policies and procedures for architects, contractors, and telecommunications design professionals who are involved in telecommunications projects on the Fort Hood Installation. The manual should be used as a guide for projects providing telecommunications cabling, to include Outside Plant Copper, Fiber Systems and Protected Distribution Systems. Work may include new or renovated buildings and may consist of upgrading and or adding cabling infrastructures.

b. This manual assumes that the user is familiar with telecommunications distribution systems, the cable and hardware used in them, the cable pathways and support structures and the installation of cabling and network systems in buildings and Fort Hood Installation environments. It is not intended to be a training manual in telecommunications distribution systems or replace existing industry standards.

c. Terminology used throughout this document will adhere to Building Industry Consulting Service International (BICSI). Requirements will adhere to the American National Standards Institute (ANSI), Telecommunications Industry Association (TIA), Electronic Industry Alliance (EIA), and Rural Utility Standards (RUS).

d. Request for Information (RFI) and Waivers of specific design issues must be submitted through CoE/DPW and approve by Plans, Network Enterprise Center (NEC), Fort Hood.

2.

a. Plans, Network Enterprise Center is responsible for Fort Hood Installation inside and outside Telecommunications Systems Facilities, and network connectivity and associated backbone planning review. Additionally, Plans will be responsible for the review of all Quality Assurance Testing Submittals for new or upgraded Telecommunications Facilities.

b. These responsibilities include the review of all new telecommunications project plans, and require the following review items from the Directorate of Public Works:

1) Copies of CAD floor plans showing Telecommunications Outlet locations for new or renovation construction projects.

2) Copies of CAD for Building Telecommunications Distribution layout.

3) Copies of CAD for Telecommunications Room (TR) Design depicting Equipment Racks, Cable Support Structures, Entrance Facilities Termination, Riser Distribution Termination, Patch Panels, Conduit, etc.

4) Copies of CAD for new Outside Plant Manhole, Hand Hole, Duct and Aerial Systems.

5) Copies of CAD for proposed Outside Plant Copper and Fiber Routes.

6) Copies of Quality Assurance Testing Submittals for Outside/Inside Fiber Optic and Copper

Plant Cabling.

c. Networking, Network Enterprise Center is responsible for the Fort Hood Installation network

February 2013 Page 7 of 67 connectivity. In as much as this requires the appropriate electronic devices to be provided to NEC Networking Branch for programming and installation, Directorate of Public Works will coordinate the purchase of electronic devices through Plans, Network Enterprise Center. Electronic devices not approved through Plans, Network Enterprise Center will not be installed on the Fort Hood Installation Network.

Note: All comments on reviews must be incorporated into the design documents in full or an explanation outlining why they were excluded from such design documents. Status must be given to Plans, Network Enterprise Center regarding all comments submitted for inclusion in design documents.

d. Architects, contractors, and telecommunications design professionals must indicate, on the design drawings, and in the design specifications, the locations and specification of the physical infrastructure required for a complete telecommunications cabling pathway and distribution system. This physical infrastructure shall include:

1) Cabling and wiring for a complete telecommunications system.

2) The infrastructure necessary to support the horizontal and vertical riser cable plants.

3) The infrastructure necessary to interconnect buildings, to include conduit, manholes, hand holes, pull boxes, building entrances, cables, splice locations, and connection to communication resource service points.

4) Grounding and bonding requirement and points.

5) Electrical service requirements at the building distribution frames/equipment racks.

3. The Telecommunications Distribution System Design Process

a. The Fort Hood telecommunications distribution design is divided into six segments:

1) The Horizontal Segment, Chapter 2, consists of the type and number of terminations, riser cabling types and lengths, associated pathways and related hardware.

2) The Equipment and Telecommunications Room, Chapter 3, consisting of required size, locations and pathways entering and exiting the Telecommunications Rooms.

3) The Building and Intermediate Distribution Frames/Racks, Chapter 4, consisting of hardware for terminating the outside/inside distribution cable.

4) The Riser Segment, Chapter 5, refers to the riser cable, slots and conduits that enable cable to be passed between floors, office spaces and Telecommunications Rooms.

5) The Outside Plant Segment, Chapter 6, references the cabling and infrastructure that interconnect buildings or systems on the Fort Hood Installation.

6) Protected Distribution Systems (PDS), Chapter 7, refers to the installation procedures of PDS.

b. The network electronic equipment, to include configuration, installation and sustainment, is traditionally accomplished by Network Branch, Network Enterprise Center.

February 2013 Page 8 of 67

4. Overview of this manual

a. This manual is divided into seven chapters each divided into three or more paragraphs. Chapter 1 is an overview of this manual. The responsibilities of Network Enterprise Center, Architects, Contractors and Telecommunications Design Professionals is awareness compliance and professional execution of this guidance.

b. Chapters 2 through 7 describe in detail the requirements of the Telecommunications Distribution planning and designing Telecommunications Infrastructure to be used on the Fort Hood Installation.

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February 2013 Page 10 of 67

Intentionally Left Blank

CHAPTER 2 THE HORIZONTAL SEGMENT

1. The Design Process

a. The horizontal segment consists of the following elements:

1) The horizontal cable and connection hardware that provide the means for transporting the telecommunications signals between the building distribution frame and the termination point in the work area.

2) The horizontal cabling pathways and spaces that distribute and support the horizontal cable and connecting hardware between the building distribution frame and the work area.

Note: Cables that interconnect in the building distribution frame on the same floor, while physically horizontal in orientation, are considered part of the riser segment.

b. The following section describes the policies and procedures for design activities on the Fort Hood Installation:

1) Determine the type and number of modular terminations in the work areas.

2) Identify the types and lengths of cable used in the horizontal segment.

3) Determine termination hardware requirements.

4) Design the structures necessary to support the horizontal cabling.

5) Assign the proper identifying information and mark the terminations in the work area and the distribution frame.

6) Cable testing procedures.

2. The Type and Number for Modular Terminations

a. Modular Terminations fall into three possible configurations: Basic, Enhanced, and Integrated.

b. Basic Modular Terminations are those that support voice, data or CATV applications. This consists of a single face plate with one Category 6 Modular Jack supported by one 4-pair unshielded twisted pair (UTP) Category 6 cable or CATV Jack supported by one 75 ohm cable. A basic outlet can be used for a wall phone, fax machine, Video or can augment an existing work area for additional data access.

(See Fig. 2-1)

c. Enhanced Modular Terminations are those that support both voice and data applications. They consist of a single face plate with two Category 6 Modular Jacks supported by two 4-pair (UTP) Category 6 cables. Enhanced outlets are the standard configuration on the Fort Hood Installation.

(See Fig. 2- 2)

d. Integrated Modular Terminations are those that support complex systems including voice, data, and video applications. They consist of a single face plate with three or more Category 6 Modular terminations supported by three or more 4-pair UTP Category 6 cables. It can also consist of a combination of Category 6 Modular terminations and Fiber Optic Terminations supported by single mode optic cables.

(See Fig. 2-3)

February 2013 Page 11 of 67

BASIC FACEPLATE

FIGURE 2-1

Single Modular or CATV Termination

ENHANCED FACEPLATE

FIGURE 2-2

Dual Modular Termination (Commonly Used)

INTEGRATED FACEPLATE

FIGURE 2-3

Multiple Modular and Fiber Optic Termination

February 2013 Page 12 of 67

e. At a minimum two Enhanced Modular Terminations shall be provided in each office and conference room.

f. At least one Basic Modular Termination must be provided at entries for wall-mounted telephone.

g. At least one Basic Modular CATV and one Integrated Modular Termination must be provided in each conference room.

h. At least one Basic Modular and CATV Termination must be provided in each barracks space.

i. At a minimum six Enhanced, two Basic CATV and one Integrated Modular Terminations must be provided in each classroom.

j. For planning purposes, when actual outlet densities are not known, reasonably accurate count estimations can be obtained based on the size and dedicated usage of the facility space. Calculations can be based on gross square footage and the average outlet density for the specific category of facility space.

Specific facility space category and related outlet density per square feet are listed below and fall within the range outlined in TIA/EIA-569-A and the I3A Technical guide.

Outlet Density Facility Space Category Area (SF)

Administrative Space 80

Laboratory/Technical Space 100

Barracks Space 315

Medical/Clinic Space 80

Classroom Space 80

Warehouse Space 5000

General Instruction/Other Space 500

Clerical 140

High Density 50

k. Electrical gang boxes will be sized for the type of Modular Termination Faceplate being installed. From each electrical gang box a minimum of 1 conduit shall be installed. The conduit will be installed to the cable pathway support system.

(See Fig. 2-4)

Note: Electrical gang boxes can be either wall mounted or recessed (recessed is the preferred method) with conduit that provides for the proper ratio of space for the cable being installed. Use of power poles will be minimized.

February 2013 Page 13 of 67

FIGURE 2-4

3. Cable Types and Lengths

a. Cable types fall into two categories, UTP (unshielded twisted pair) and single mode fiber optic.

1) UTP cable will be 4-pair, 23 AWG, 100 Ohm, solid conductor that meets ANSI/TIA/EIA

568-C.0 cabling specifications for Category 6 cable, including any/all Amendments and Bulletins, and must meet specifications and performance requirements. Use only cable that passed the Underwriters Laboratory (UL) LAN certification program and is labeled with UL acceptance markings. Plenum cables shall be used at all times.

2) Fiber optic cable will be a minimum of 6-strands, single mode, 8.3/125 micron, tight-buffered, indoor plenum cable.

b. Cabling and associated components must comply with Article 770 and 800, National Electrical Code (NEC). Cable installed indoors must meet fire codes. That means the jacket must be rated for fire resistance, with ratings for general use, riser (a vertical cable feeds flames more than horizontal) and plenum. Most indoor cables use PVC (polyvinyl chloride) jacketing.

c. All cabling will be UL Listed Type CMP, OFNR or OFNP plenums without conduit. Fiber optic cabling is designated either OFN-FT4 (Non-plenum) or OFN-FT6 (Plenum). The cable sheath will be marked with the UL listing. (See table 3-1)

d. Horizontal UTP and fiber optic cables will not be spliced, nor will these cables contain manufacture…