Attachment 1 - Appendix A.pdf

PDF 4 MB Posted Mar 19, 2021

Attached to: FY21 Micro-surfacing Package Federal contract opportunity
Solicitation number: W91151-21-B-0004
Issued by: Department of the Army Materiel Command Mission and Installation Contracting Command Fort Hood

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Other files for this federal contract opportunity

Other files attached to FY21 Micro-surfacing Package, newest first.
File	Type	Posted
Technical Exhibit E - Revised Drawings.pdf	PDF	Apr 14, 2021
Amendment 01 Solicitation 21-B-0004 FY21 Micro-surfacing Package.pdf	PDF	Apr 14, 2021
Site Visit Sign In Roster Solicitation 21-B-0004 FY21 Micro-surfacing Package.pdf	PDF	Mar 31, 2021
Technical Exhibit A - Specifications.pdf	PDF	Mar 19, 2021
Technical Exhibit D - Special Provision 350.pdf	PDF	Mar 19, 2021
Technical Exhibit C - Special Specification 3028 Onyx.pdf	PDF	Mar 19, 2021
Technical Exhibit B - Drawings.pdf	PDF	Mar 19, 2021
Solicitation W91151-21-B-0004 FY21 Micro-surfacing Package.pdf	PDF	Mar 19, 2021

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Headquarters III Corps, Fort Hood Directorate of Public Works (DPW)

Attachment 1 Appendix A

July 2018

Directorate of Public Works Engineering Division

US Army, III Corps 4612 Engineer Dr.

Fort Hood, TX 76544

APPENDIX “A” TABLE OF CONTENTS

SECTION 1 – GENERAL

DESCRIPTION:

• Sample Submittal Register

• Form 4025, Submittal Transmittal Sheet

• Contract Bi-Weekly Progress Report Form 1

• Refrigeration Equipment Service Log

• EPA: Refrigeration Recovery Form

• Emissions Inventory Sheet

• Contractor Hazardous Materials Inventory and Consumption Log

• Landfill Permit

• Customer Service Inspection Certificate (CSI)

• Coordination for Land Excavation and Water (Form 200-X10)

• DPW-OMD Line Marking for Land Excavation Form

• Landscaping on Fort Hood

• Accident Investigation Report

• Sample-Contractor Quality Control Report

• Preparatory Phase Checklist

• Initial Phase Checklist

• Operation and Maintenance Training

• Fort Hood DPW Building Equipment Inventory

• Fort Hood Key SOP (Mechanical Keys and Electronic Keys)

SECTION 2 – NETWORK ENTERPRISE CENTER (NEC)

• Information Infrastructure Installation Guidelines

SECTION 3 – AMERICAN WATER

• American Water Design Guide

SECTION 4 – PRIVATIZED UTILITIES ON FT. HOOD

• Ft. Hood Privatized Utility Policy

• Connection Charge Agreement

SECTION 1 - GENERAL

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Form Approved OMB No. 2060-0256

ENVIRONMENTAL PROTECTION AGENCY

REFRIGERANT RECOVERY OR RECYCLING DEVICE

ACQUISITION CERTIFICATION FORM

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 mail it to the appropriate EPA Regional Office. BOTH THE INSTRUCTIONS AND MAILING ADDRESSES CAN BE FOUND ON THE

REVERSE SIDE OF THIS FORM.

PART 1: ESTABLISHMENT INFORMATION

Name of Establishment Street

(Area Code) Telephone Number City State Zip Code

Number of Service Vehicles Based at Establishment County

PART 2: REGULATORY CLASSIFICATION

Identify the type of work performed by the establishment. Check all boxes that apply.

9 Type A - Service small appliances 9 Type B - Service refrigeration or air-conditioning equipment other that small appliances 9 Type C- Dispose of small appliances 9 Type D - Dispose of refrigeration or air-conditioning equipment other than small appliances

PART 3: DEVICE IDENTIFICATION

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

1. G

2. G

3. G

4. G

5. G

PART 4: CERTIFICATION SIGNATURE

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

Part 1: 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.

Part 2: 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.

Part 3: 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.

EPA REGIONAL OFFICES

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

BOB.MILLENBACH

Typewritten Text

Proposed Project Emissions Inventory Questionnaire for New Sources

TCEQ Title V Operating Permit Decision Support System

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.

For information on installing or configuring the Adobe Acrobat Reader click here. Even if you have the Adobe Acrobat Reader installed, you may need to configure it to work as required (The hyperlinking capability will not work unless the reader opens up within the browser window).

Guidance for using the Decision Support System Decision Support System for:

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.

http://www.tnrcc.state.tx.us/link.html http://www.tnrcc.state.tx.us/link.html http://www.adobe.com/ http://www.adobe.com/ http://www.tnrcc.state.tx.us/permitting/airperm/opd/pdfhelp.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/pdfhelp.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/dssgui.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/dssgui.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/59/59hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/59/59hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/60/60hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/60/60hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/61/61hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/61/61hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/63/63hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/63/63hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/82/82hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/82/82hmpg.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/state/statehp.htm http://www.tnrcc.state.tx.us/permitting/airperm/opd/state/statehp.htm http://www.epa.gov/compliance/planning/data/air/adi.html http://www.epa.gov/compliance/planning/data/air/adi.html

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:

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 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=511 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=511 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=263 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=263 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=473 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=473 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=478 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=478 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=30&pt=1&ch=115&sch=C http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=30&pt=1&ch=115&sch=C http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=102 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=102 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=183 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=183 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=412 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=412

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:

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:

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 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=433 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=433 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=436 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=436 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=116&rl=110 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=116&rl=110 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=103 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=103 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=227 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=227 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=261 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=261 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=262 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=30&pt=1&ch=106&rl=262

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

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 http://www.tnrcc.state.tx.us/air/aqp/psei.html http://www.tnrcc.state.tx.us/air/aqp/psei.html

BOB.MILLENBACH

Typewritten Text

PRIME COMPANY NAME: _______________________________ CONTRACT NO: _______________________

PROJECT TITLE/LOCATION: ___________________________________________________________________

Material Name Manufacturer MSDS State Number

Average Max Daily Daily

*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____

CONTRACTOR HAZARDOUS MATERIAL INVENTORY & CONSUMPTION LOG

(EPCRA/E.O. 13423)

(container size-quantity of) Storage Quantity Quantity (lbs/gals) used in CY [ ](i.e. Liquid, Solid, Gas)

Company Using Material Listed Above Company Representative's Signature

PRIME COMPANY NAME: _______________________________ CONTRACT NO: _______________________

PROJECT TITLE/LOCATION: ___________________________________________________________________

Material Name Manufacturer MSDS State Number

Average Max Daily Daily

Page____of____

(container size-quantity of) Storage Quantity Quantity (lbs/gals) used in CY [ ](i.e. Liquid, Solid, Gas)

Continuation Sheet

CONTRACTOR HAZARDOUS MATERIAL INVENTORY & CONSUMPTION LOG

(EPCRA/E.O. 13423)

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):

Customer Service Inspection Certificate (30 TAC §290.47(d))

Customer Service Inspection Certificate Name of PWS _______________________________________PWS I.D.# ______________ Location of Service ______________________________________________________ Reason for Inspection:

New construction. __ Existing service where contaminant hazards are suspected __ Major renovation or expansion of distribution facilities __

I _____________________________, upon inspection of the private water distribution facilities connected to the aforementioned public water supply do hereby certify that, to the best of my knowledge:

(1) No direct connection between the Compliance Non-Compliance public drinking water supply and a potential source of contamination exists. Potential sources of contamination are isolated from the public water system by an air gap or an appropriate backflow prevention assembly in accordance with Commission regulations.

(2) No cross-connection between the public drinking water supply and a private water system exists. Where an actual air gap is not maintained between the public water supply and a private water supply, an approved reduced pressure-zone backflow prevention assembly is properly installed and a service agreement exists for annual inspection and testing by a certified backflow prevention assembly tester.

(3) No connection exists which would allow the return of water used for condensing, cooling or industrial processes back to the public water supply.

(4) No pipe or pipe fitting which contains more than 8.0% lead exists in private water distribution facilities installed on or after July 1, 1988.

(5) No solder or flux which contains more than 0.2% lead exists in private water distribution facilities installed on or after July 1, 1988.

I further certify that the following materials were used in the installation of the private water distribution facilities:

Service lines Lead __ Copper __ PVC __ Other __ �Solder Lead __ Lead Free __ Solvent Weld __ Other __

I recognize that this document shall become a permanent record of the aforementioned Public Water System and that I am legally responsible for the validity of the information I have provided.

Remarks:

Signature of Inspector Registration Number

Title Type of Registration

Date

FHT Form 200-X10, April 2004 (DPW) Replaces FHT Form 420-X10

COORDINATION FOR LAND EXCAVATION & WATER USE

(III Corps and FH Reg 200-1)

CONTROL NUMBER

TELEPHONE

NAME, RANK, TITLE, AND ORGANIZATION OF REQUESTER

PROJECTED DATES OF EXCAVATION OR WATER USE

PURPOSE AND DESCRIPTION OF EXCAVATION OR WATER USE (PROJECT NO./CONTRACT NO./TITLE, ETC.)

AREA OF LAND DISTURBANCE = _________ ACRES DPW Point Of Contact:_______________________________________ Note: Permit Expires After 30 Days of Approved Start Date

EXCAVATION

I propose to dig at the locations depicted in the attached map, sketch, or overlay (For military operations, plot digging locations on transparent overlays that include two grid register marks using standard 1:50,000 topographic maps).

I understand that the proposed digging or excavation is a requirement within the scope of work to be accomplished. I will not dig or excavate before receiving written approval from the Directorate of Public Works (DPW). I understand my responsibilities and obligations pursuant to safety, property damage, personal injury, and life-threatening hazards associated with digging in the vicinity of underground utilities (including utilities such as electrical cables and pipes containing natural gas, water, sewer, liquefied fuels, and refrigerants). Severe injuries, death, and extensive property damage may occur as a result of digging through underground utilities. I am responsible for damages caused to persons or property as a result of my fault or negligence. If the exact locations of underground utilities are unknown, I will perform whatever work is necessary to determine exact locations and avoid damaging utilities.

Unless otherwise permitted, I will not excavate within 50 meters of streams, natural drains, roads, and tank trails. I will not dig or deposit excavated spoil within 10 meters of trees.

If archaeological resources (arrowheads, charcoal, bones, etc.) are discovered during excavation, I or my representative will notify DPW, 287- 1092, and suspend disturbance of the finding until DPW issues guidance.

Upon completion, I will restore the excavation site including backfilling, reshaping, and seeding to conform to surrounding topography.

For construction activities that will result in land disturbance (clearing, grading or excavating) of one acre or more, or that are part of a larger common plan of development that will ultimately disturb one or more acres of land, I will comply with the provisions of the TPDES General Permit, TXR150000, to discharge storm water from construction sites, and I will coordinate with DPW-Environmental Division, 287-6499.

WATER USE

I propose to take surface water from the location depicted in the attached map, sketch, or overlay. Include dates and amounts of proposed water use.

I understand that the proposed water supply point is a requirement within the scope of work to be accomplished. I will not divert or draw any water before receiving written approval from the Directorate of Public Works (DPW).

I understand that in addition to this permit, a Temporary Water Use Permit may be required from TCEQ, depending on the proposed water use.

SIGNATURE OF REQUESTER DATE

REVIEWED OR INSPECTED BY

(All blocks must be signed for Excavation permit. Natural Resources & Environmental Mgmt only for Water Use permit.)

NATURAL RESOURCES Sprint ELECTRIC GAS RANGE DIVISION

ENVIRONMENTAL MGMT CULTURAL RESOURCES DOIM TV CABLE WATER & SEWER

Approved under the following conditions Disapproved for the following reasons

APPROVED BY (Range Division for Training Activities, Range Safety for Live Fire Activities, DPW for all other Activities)

DATE

FHT Form 200-X10

DPW-OMD LINE MARKING FOR LAND EXCAVATION FORM

LINE MARKING FOR LAND EXCAVATION FORM EXPIRES 14-DAYS AFTER UTILITY ASSETS HAVE BEEN MARKED

CONTROL NUMBER:

*This form may take 10-Business days to process and validate.

1. NAME, RANK, TITLE, AND ORGANIZATION OF REQUESTOR: 2. PHONE NUMBER:

3. PROJECTED DATES OF EXCAVATION:

4. LOCATION & DESCRIPTION OF LAND EXCAVATION: Requestor must include an attached map

5. SITE POC: 6. POC PHONE NUMBER:

7. REQUESTOR RESPONSIBILITIES AND GENERAL EXCAVATION STATEMENTS

8. SIGNATURE OF REQUESTOR: 9. DATE:

AW: I have marked the identified excavation site for AW owned utility assets.

AW SIGNATURE: DATE:

DE: I have marked the identified excavation site for DE owned utility assets.

DE SIGNATURE: DATE:

NEC: I have marked the identified excavation site for NEC owned utility assets.

NEC SIGNATURE: DATE:

I have marked the identified excavation site for DPW-OMD owned utility assets.

DPW-OMD SIGNATURE: DATE:

DPW-OMD:

I understand that once the approved dig or excavation permit is received, I must hand dig within three feet (36 in.) on either side of the ground markings indicating the presence of an underground utility.

Section III - DPW OFFICE USE ONLY

*Line Marking for Land Excavation Forms are valid until project is complete as long as utility location markings are maintained by the requestor and excavation is started within 14-days from all utility asset markings. Each requestor performing land excavation must obtain a valid Line Marking for Land Excavation Form for excavation within the identified and approved area. If excavation has not begun 14-days after approval, the form is no longer valid and the requestor will be responsible for submitting a new Line Marking for Land Excavation Form.

I understand that I am responsible for damages caused to persons or property as a result of my fault or negligence. If the exact location(s) of underground utilities are said to be unknown, I will perform whatever work is necessary to determine exact location(s) and avoid damaging utilities.

If archaeological resources (arrowheads, charcoal, bones, etc.) are discovered during excavation, I or my representative will notify DPW Cultural Resources at 287-1092 and suspend all digging activities pending further guidance from DPW-Cultural Resources.

I understand that it is my responsibility to review and comply with my contract requirements.

I understand that I must coordinate with external utility system owners by contacting them directly or by calling 811 for assistance.

I understand my responsibilities and obligations pursuant to safety, property damage, personal injury, and life-threatening hazards associated with digging in the vicinity of underground utilities (including utilities such as electrical cables and pipes containing natural gas, water, sewer, liquefied fuels, and refrigerants). Severe injuries, death, and extensive property damage may occur as a result of digging through underground utilities.

I understand that I cannot not dig or excavate without receipt of an approved excavation permit within Fort Hood Cantonment Areas.

Section I

*This DPW-OMD Line Marking for Land Excavation Form is required for coordination of land excavation. Upon receipt of a validated form, the requestor may proceed with coordination of land excavation IAW contractual and regulatory excavation requirements.

Section ll – REQUESTOR RESPONSIBILITIES

I understand this Line Marking for Land Excavation Form is required for coordination of land excavation and upon receipt of a validated form, I may proceed with coordination of land excavation IAW contractual and regulatory excavation requirements

I propose to dig at the locations within Fort Hood cantonment areas depicted in the attached map and understand that G3 or DPTMS-Range Division is responsible for establishing excavation procedures and controlling access in maneuver and live fire training areas on the installation (AR 350-19).

*This form must be obtained and completed prior to the planned site excavation.

REPLY TO

ATTENTION OF

IMHD-PWE

DEPARTMENT OF THE ARMY

US ARMY INSTALLATION MANAGEMENT COMMAND

HEADQUARTERS, UNITED STATES ARMY GARRISON, FORT HOOD

FORT HOOD, TEXAS 76544-5002

MEMORANDUM FOR SEE DISTRIBUTION

SUBJECT: Memorandum of Instruction (MOI)-Landscaping on Fort Hood

2 7 JUN 2012

1. Purpose. To establish procedures which would allow units and other Fort Hood areas to be landscaped with vegetation which is native to the Fort Hood region .

2. Applicability. This MOl applies to all units, directorates, and Family housing areas on Fort Hood.

3. Responsibilities.

a. Draw plans of the landscape area to facilitate plant placement by type and height or growth characteristics and estimate cost.

b. Lay out beds or planting sites on the ground.

c. Obtain an approved excavation permit (FH 420-X1 0).

d. Plant and water.

e. Develop a long-term maintenance schedule and apply.

4. The point of contact for excavation permits is DPW, Maintenance Division , 287-9735.

Encl

DISTRIBUTION :

lAW FH Form 1853: A

:f:t~t;k-

COL,AR ~

Commanding

AMBER.L.DANKERT

Highlight

Planting and Care of Trees and Shrubs

1. Locate and mark planting sites and apply for an approved excavation permit (FH 420-X1 0). A permit is required prior to any digging on Fort Hood and necessary to prevent damage to the underground utility systems.

2. Select the right plants for the right locations. Consider future plant size in relation to conflict with sidewalks, drives, buildings, streets, and overhead utility lines. See the approved plant list for guidance on plant heights.

3. Locate and dig holes so that the hole is two to three times the diameter of the container and no deeper than the container. Keep all original topsoil for backfilling. Be certain that hole has rough and uneven edges and is irregular in size, as this will encourage the new roots to spread and not become root-bound within the hole. Plant only as deep as the level of the dirt in the original pot; planting too deeply may kill the plant. See attached diagram.

4. Always handle plants by the container or the ball, never by the stems, as this will damage the plant. If the plant is root-bound, make two cuts across the bottom layer of roots and several cuts along the sides to loosen the roots.

5. Set the plant in the hole vertically and remove the container or the burlap and wire.

Backfill only with the original soil. Do not backfill with compost, peat moss, or other materials. Add one-third of backfill soil at a time; tamp very lightly, and use slow running water to settle the soil and help secure the plant. Repeat this process until the hole is full and thoroughly watered.

6. It is recommended that you install a landscape fabric. Place fabric beneath edging so that it covers the entire surface of the bed. Use a fabric, which allows air and water to penetrate and restricts weeds, but do NOT use a solid plastic film.

7. If desired , you may install edging . Metal edging, installed 4 inches below the surface and 2 inches above, is preferred because it will help to keep grass from invading into the planting area. However, stone edging, installed no more than one high , may be installed around individual trees or around shrub beds.

8. Place a 3- to 4-inch-thick layer of mulch around all plants to keep them free of weeds and grass. Use only shredded hardwood mulch, hardwood chips, or cedar mulch. Do not use pine bark mulch. Do not use rock of any type instead of mulch . For planting beds, mulch the entire bed. For individual plantings of trees or shrubs, mulch 2 to 3 feet around the trunk in every direction.

9. For trees , do not use tree stakes or guy wires of any kind. These actually weaken trees. Also , do not wrap any material around the base of the trunk. These encourage problems with insects and diseases. Do not prune trees and shrubs at planting time.

Do not paint trees. The only exception to the no-staking rule is for very large (greater than 4-inch trunk) balled and burlapped trees. These trees may be staked for a period not to exceed 2 years, after which time all stakes and guy wires must be removed .

10. Do not plant trees and shrubs without a commitment to care for them. Trees and shrubs will need to be watered when rainfall is not sufficient; a rain of at least 1 inch per week is sufficient. When rainfall is less than 1 inch , each tree and shrub will need to be watered once per week during the summer months and every other week during the fall , winter, and spring months for 1 to 2 years . A slow trickle of water from a water hose for one hour is the preferred method of watering. Sprinkling, especially during the summer months, is very wasteful. More water is lost to evaporation rather than soaking into the soil.

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Plant List for Landscaping on Fort Hood

*indicates plants native to Fort Hood

Common name Scientific Name Description

LARGE TREES

Anacua (Sandpaper Ehretia anacua up to 30 feet tall ; sun/part shade; evergreen or tree) partly deciduous; often with multiple trunks; may die back in cold winters; white, fragrant flowers, yellow-orange fruit; needs frequent watering until established

Bald cypress Taxodium distichum 20-50 feet tall ; sun/part shade; soft, ferny, deciduous foliage, wet areas only

Big-tooth maple* Acer grandidentatum 20-50 feet tall ; full sun; needs very little water;

golden to red fall color

Black walnut * Jug/ans nigra up to 50 feet tall; sun/part shade; slow-growing if not in moist, rich, sunny sites; wet areas only

Bur oak* Quercus macrocarpa 60-80 feet tall, 50 feet spread; sun/part shade;

needs deep, rich soil; very large leaves and acorns

Cedar elm * Ulmus crassifo/ia up to 70 feet tall, 40 feet spread; sun/part shade;

good for narrow spaces; yellow-golden fall color

Chinkapin oak* Quercus muehlenbergii up to 50 feet tall; sun/part shade; prefers deep soil; yellow to brown fall color

Escarpment black Prunus serotina var. up to 25 feet tall; sun/part shade; white flower cherry eximia clusters followed by small black cherries; yellow fall color; needs moist soil

Lacey oak Quercus laceyi (Q. up to 20 feet tall; part shade; slow growth rate;

glaucoides) interesting blue-green leaf color

Monterrey oak Quercus polymorpha up to 50 feet tall ; sun/part shade; deciduous to

(Mexican white oak) evergreen; prefers well-drained soil ; bronze leaf color

Pecan * Carya illinoenensis up to 90 feet tall; full sun; needs deep, rich soil ;

ed ible nuts

Plateau live oak* Quercus fusiform is (Q. up to 30 feet tall; sun/part shade; evergreen;

virginiana) susceptible to oak wilt

Shumard oak Quercus shumardii up to 50 feet tall; sun/part shade; prefers moist, deep soil; red to yellow fall color

Texas red oak* Quercus buckleyi up to 50 feet tall; sun/part shade; red to yellow fall foliage

Texas white ash* (NOT Fraxinus texensis (NOT F. 40-50 feet tall; sun/part shade; fast growing;

Arizona ash or Fan Tex velutinus) yellow to orange fall color ash)

SMALL TREES

Anacacho orchid tree Bauhinia lunarioides 6-12 feet tall; part shade; single or multi-stemmed trunk; clusters of white, orchid-like flowers; should be planted on south side of buildings to protect from frost

Blanco crabapple Pyrus ioensis var. texana up to 12 feet tall ; full sun; pink flowers in spring, (Malus ioensis var. interesting fruit texana)

Carol ina buckthorn * Rhamnus caro/iniana up to 15 feet tall; sun/shade; large glossy leaves;

(Frangula caroliniana) small purple fruit

Desert willow Chilopsis linearis up to 15 feet tall ; sun/shade; showy pink flowers;

avoid overwatering

Eve's necklace* Styphnolobium affine up to 20 feet tall; part shade; beautiful pink (Sophora affinis) flower clusters, fruit black bead-like pods; needs well-dra ined soil

Little walnut* Juglans microcarpa up to 20 feet tall; part shade; yellow-green foliage

Mexican plum * Prunus mexicana up to 20 feet tall; sun/part shade; white, fragrant flowers in early spring; flaky bark

Pra irie flame-leaf Rhus /anceo/ata up to 20 feet tall; sun; small wh ite flowers in sumac* summer, red berries; brilliant red fall color; will spread to become several small trees, needs room to expand

Rusty blackhaw Viburnum rufidulum 10-20 feet tall ; sun/part shade; large white viburnum * flowers in spring, red fall color

Smoketree Cotinus obovatus 12-20 feet tall; sun/part shade; flowers and fruit look like smoke; orange fall color

Texas persimmon* Diospyrus texana 10-15 feet tall; sun/part shade; semi-evergreen;

multi-trunked; interesting peeling bark

Texas redbud * Cercis canadensis var. 20-30 feet tall ; sun/part shade; pink flowers early texensis spring

TALL SHRUBS

Bee-brush Aloysia gratissima up to 10 feet tall ; sun/part shade; small white, vanilla-scented flowers in spikes; can be pruned into hedge

Cenizo Leucophyllum frutescens 2-6 feet tall, 4-6 feet wide; sun/part shade; silvery gray shrub with bright pink-lavender flowers;

several months of flowering; good hedge or screen

Deciduous holly* /lex decidua 12-20 feet tall ; sun/part shade; striking red berries on female plants persist into winter

Dwarf wax myrtle Myrica pusilla 8-12 feet tall; sun/part shade; evergreen; golden yellow flowers; small blue fruits

Evergreen sumac* Rhus virens 4-12 feet tall, 6-8 feet wide; full sun; th ick evergreen foliage, may bronze after a freeze; red berries in late fall; do not overwater

Golden-ball lead tree Leucaena retusa up to 12 feet tall; sun/part shade; yellow puff flowers in spring, summer and fall ; do not…

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