TE-09o Fugitive Dust Control Form 15-Loading.pdf
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- W911S6-27-B-A001
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This is a Fugitive Dust Control Plan form used by Dugway Proving Ground for construction and demolition trucking loading activities. The form serves as a compliance document for managing fugitive dust emissions during truck loading operations involving construction debris, demolition materials, rock, or soil transported on or off site.
The form requires completion of general information fields including location, start and end dates, point of contact information, and site description. Operators must select at least one best management practice (BMP) from three options for stabilizing surface soils in the loading area: pre-watering and maintaining stabilized soil conditions (BMP 15-01), applying chemical stabilizers (BMP 15-02 with specification of chemical name), or minimizing drop height during loader bucket dumping (BMP 15-03). If dust suppression is used, a logbook is mandatory containing date, time, suppression type, amount in gallons, purpose, and application location. The form enforces trackout prevention requirements under Utah Administrative Code R307-205-6(2), mandating that operators keep materials from being deposited on paved roads except at designated sites and requiring prompt road cleaning if fugitive dust materials are deposited. Completed forms 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. The signatory attests understanding and compliance with all Dugway Proving Ground FDCP requirements and selected BMPs.
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Text version
Environmental Programs FDCP-15 Air Quality Program Revision 0
Dugway Proving Ground Fugitive Dust Control Plan Form 15 Construction & Demolition
Trucking Loading with Materials Activity Description: The loading of trucks with materials, including construction or demolition debris, rock or soil, to be transported on or off site.
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 the critical mitigation area:
Stabilize surface soils where truck loading operations occur
BMP 15-01 Pre-water and maintain surface soils in a stabilized condition where loaders, support equipment and vehicles will operate.
BMP 15-02 Apply and maintain a chemical stabilizer on surface soils where loaders, support equipment and vehicles will operate.
(Name of chemical: )
BMP 15-03 Empty loader bucket slowly and keep loader bucket close to the truck to minimize the drop height while dumping.
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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