TE-09k Fugitive Dust Control Form 11-Disturbed Soil.pdf
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- Solicitation number
- W911S6-27-B-A001
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This is a template form for the Dugway Proving Ground (DPG) Fugitive Dust Control Plan (FDCP) for construction and demolition activities involving disturbed soil. The form applies to any activity where soil is broken up, moved, or its physical characteristics are altered.
The form requires contractors to complete general information fields including location(s), start and end dates, point of contact information, and site description. Contractors must select at least one best management practice (BMP) from two critical mitigation areas: (1) limiting disturbance of soils through fencing, barriers, vehicle speed reduction, or similar techniques, and (2) stabilizing disturbed soil through water application, chemical stabilizers, wind breaks, or covers. If suppression methods are used, contractors must maintain a logbook documenting the date, time, suppression type, amount in gallons, purpose, and location applied. In accordance with Utah Administrative Code R307-205-6(2), contractors must prevent material trackout onto paved roads and promptly clean any roads where fugitive dust materials are deposited. The completed form and applicable logbook entries must be submitted to the Environmental Program's Air Program Manager (boyd.roberts.civ@mail.mil) upon operation completion or annually by calendar year end, whichever occurs first.
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Environmental Programs FDCP-11 Air Quality Program Revision 0
Dugway Proving Ground Fugitive Dust Control Plan Form 11 Construction & Demolition
Disturbed Soil Activity Description: Whenever soil is broken up, moved, or physical characteristics are altered.
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:
Limit disturbance of soils where possible
BMP 11-01 Limit disturbance of soils with the use of fencing, barriers, barricades, and/or wind barriers.
BMP 11-02 Limit vehicle mileage and reduce speed.
Stabilize and maintain stability of all disturbed soil throughout construction site generating fugitive dust.BMP 11-03 Apply water to stabilize disturbed soils. Soil moisture must be maintained such that soils can be worked without
BMP 11-04 Apply and maintain a chemical stabilizer. (Name of chemical: ) BMP 11-05 Use wind breaks.
BMP 11-06 Apply cover. (natural or synthetic)
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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