TE-09l Fugitive Dust Control Form 12-Disturbed Land.pdf
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- Solicitation number
- W911S6-27-B-A001
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This is an environmental compliance form template for Dugway Proving Ground's Fugitive Dust Control Plan (FDCP) addressing construction and demolition activities on disturbed land. The form applies to large tracts of broken up or physically altered land that will not have continuing activity for more than 30 days.
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: preventing access to limit soil disturbance (BMP 12-01 using fencing, ditches, vegetation, berms, or barriers) and stabilizing soil through five options including chemical stabilizers (BMP 12-02), vegetation (BMP 12-03), paving or surface rock (BMP 12-04), wind breaks (BMP 12-05), or water application to maintain soil moisture (BMP 12-06). If suppression methods are used, contractors must maintain a logbook documenting date, time, suppression type, amount in gallons, purpose, and location applied. The form also requires compliance with Utah Administrative Code R307-205-6(2) regarding trackout prevention on paved roads. Completed forms and applicable logbook entries must be submitted to the Environmental Programs Air Program Manager at boyd.roberts.civ@mail.mil upon completion of operations or annually by calendar year end, whichever occurs first.
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Text version
Environmental Programs FDCP-12 Air Quality Program Revision 0
Dugway Proving Ground Fugitive Dust Control Plan Form 12 Construction & Demolition
Disturbed Land Activity Description: Large tracts of broken up or physically altered land that will not have continuing activity for more than 30 days.
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:
Prevent access to limit soil disturbance
BMP 12-01 Prevent access by fencing, ditches, vegetation, berms or other suitable barriers.
Stabilize soil
BMP 12-02 Apply and maintain a chemical stabilizer on disturbed soils. (Name of chemical: ) BMP 12-03 Stabilize disturbed soil with vegetation.
BMP 12-04 Pave or apply surface rock.
BMP 12-05 Use wind breaks.
BMP 12-06 Apply water and maintain soil moisture sufficient to avoid generating fugitive dust.
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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