TE-09j Fugitive Dust Control Form 10-Demolition.pdf
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- W911S6-27-B-A001
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This is a template form for documenting fugitive dust control measures during mechanical demolition activities at Dugway Proving Ground (DPG).
The form requires contractors to complete general information fields including location(s), start and end dates, point of contact information, and site description. For fugitive dust emission control, contractors must select at least one best management practice (BMP) from four critical mitigation areas: (1) stabilize surface soils where support equipment and vehicles will operate, with options including pre-watering, chemical stabilizers, or paving; (2) stabilize demolition debris during handling by applying water; (3) stabilize debris following demolition using water or chemical stabilizers; and (4) stabilize surrounding areas following demolition using water or chemical stabilizers. If any suppression method is used, contractors must maintain a logbook documenting the date, time, type of suppressant, amount in gallons, purpose, and location applied. The form also establishes trackout prevention requirements in accordance with Utah Administrative Code R307-205-6(2), requiring contractors to prevent material from being deposited onto paved roads outside designated deposit sites and to clean roads promptly if deposits occur. Completed forms and corresponding logbook entries must be submitted to the Environmental Program's Air Program Manager at boyd.roberts.civ@mail.mil upon completion of operations or annually at the end of each calendar year, whichever occurs first.
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Text version
Environmental Programs FDCP-10 Air Quality Program Revision 0
Dugway Proving Ground Fugitive Dust Control Plan Form 10 Construction & Demolition Mechanical Demolition
Activity Description: Mechanical/manual destruction and removal of walls, stucco, concrete, freestanding structures, buildings and other structures.
General Information
Location(s): Start Date: End Date:
Point of Contact: Email: Phone Number:
Description of site:
Fugitive Dust Emission Control Techniques Select at least one best management practice (BMP) for each critical mitigation area:
Stabilize surface soils where support equipment and vehicles will operate
BMP 10-01 Pre-water and maintain surface soils in a stabilized conditions.
BMP 10-02 Apply and maintain a chemical stabilizer to surface soils. (Name of chemical: ) BMP 10-03 Pave operational areas.
Stabilize demolition debris during handling
BMP 10-04 Apply water.
Stabilize debris following demolition
BMP 10-05 Apply water.
BMP 10-06 Apply a chemical stabilizer. (Name of chemical: )
Stabilize surrounding area following demolition
BMP 10-07 Apply water.
BMP 10-08 Apply and maintain a chemical stabilizer to stabilize. (Name of chemical: )
Logbook Requirement If suppression is used, a logbook is required, at minimum, it must contain: the date, time, type of suppression used (i.e. water/chemical suppressant), amount (in gallons), purpose and location applied.
Trackout Prevention In accordance with Utah Administrative Code R307-205-6(2), any person(s) performing fugitive dust emission activities will to the maximum extent possible, keep material from being deposited onto any paved road other than a designated deposit site. Any such person(s) who deposits materials that may create fugitive dust on a paved road shall clean the road promptly.
*By signing you attest that you have read and understand the requirements of the DPG FDCP and will follow the BMPs you have selected.
Signature Date This form is to be completed and kept on record according to the requirements found in the Dugway Proving Ground (DPG) Fugitive Dust Control Plan (FDCP). Copies of form(s) and corresponding logbook entries (if applicable) shall be provided to EP, Air Program Manager, upon the completion of operation(s) and/or annually at the end of each calendar year whichever occurs first. Submit completed form and applicable logbook entries in hardcopy or electronically, via email to Environmental Program’s (EP) Air Program Manager: boyd.roberts.civ@mail.mil
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