11.4.2_Air_Quality_Assessment_Form.xls

XLS spreadsheet 451 KB Posted Jan 24, 2018

Attached to: Chloride Dust Palliative
Solicitation number: W911RZ-18-Q-0024
Issued by: Department of the Army Materiel Command Mission and Installation Contracting Command Fort Carson

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11.4.2 Air Quality Assessment Form

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			FORT CARSON AIR QUALITY ASSESSMENT FORM
			Contact The Fort Carson Air Program
MAKE SUBMISSIONS TO THE ATTENTION OF EITHER
Emma Buccambuso, Air Qualtiy Program Manager
	E-Mail:	emma.e.buccambuso.civ@mail.mil
	Phone:	719-526-6601
John Wachter, Chief Compliance Branch
	E-Mail:	john.p.wachter.civ@mail.mil
	Phone:	719-526-8893
Environmental Division Fax: 719.526.2091
			Prepared by the FTC Directorate of Public Works - Environmental Division
			Air Quality Program
				Version 4.12-0, approved for release 4/1/2012

		Air Quality Assessment Form
								Version 4.12-0
		INSTRUCTIONS
Section 1							About This Guide
Introduction
This guide is intended to provide Project Proponents, Contractors, and DPW
staff with the basic and essential information required to maintain
compliance with the various AIR EMISSIONS CONTROL regulatory agencies,
statutory requirements, permits, and sustainability efforts that Fort Carson
(FTC) must adhere to.
The AIR QUALITY ASSESSMENT form (AQA) has been integrated into this guide,
and is the essential reporting and planning document used by the Air Program
to ensure compliance with the various New Source Review laws, Ozone Depleting
Substance management, New Source Performance Standards, the FTC Title V
Operating Permit (95OPEP110), Green House Gas Reporting, General Conformity,
and Prevention of Significant Deterioration (PSD) regulations.
Responsibility
The Proponent / Contractor is responsible for reading and understanding the
requirements outlined in this guide in there entirety, and then completing
the applicable portions of the Air Quality Assessment form.
The Air Program will analyze the project / action to determine if a threshold
of significance will be exceeded and then document the findings in the NEPA
review. You may be contacted to gather additional information for further
analysis. A full general conformity analysis, PSD permit, or Construction
permit (New Source Review (NSR)) MAY BE REQUIRED. Please be advised that any
required permit MUST BE RECEIVED PRIOR TO THE START OF CONSTRUCTION, and can
take anywhere from 120 to 180 days to receive (PSD permits can take 18+ months).
AQA Form Instructions
1.) Complete only the AQA form sections (1 - 6) that are applicable to your project, activity, or task. If a section does not apply, use the check box at the top of the section to indicate so. It is critical that you provide accurate information regarding the proposed activity as it will be come the basis for required permit and NEPA actions.
2) Part A and Part B Requirements: The POC for the project is to determine what portions of the AQA to be completed for submission to the FTC Air Program. Depending on the air requirement being addressed, the AQA should be submitted no less than 3 weeks prior to the initiation of the proposed project. NOTE: for air quality permits on new sources, the lead time is 180 days prior to construction. Part B requirements, if applicable, are due at the conclusion of the project or on an annual basis if the project spans multiple years.
				Electronic submission is preferred.
3.) Provide all required data in the green shaded cells if applicable. Several
cells contain conditional formatting and data validation (drop down) that will
require the preparer to select the most approximate match for the data to be
provided.
FTC Project Compliance Guide (Air Program)							1 - 1
Section 1 Continued							About This Guide
	In the box below place an "X" next to the air quality area you anticipate submitting information to
	the Fort Carson Air Program. By clicking on the title you will be linked to information regarding
	that air quality area. By clicking on the Section Tab you will be hyperlinked to the specific data
	information sheet.
						Section Tab
		Section 1 Data Required for ALL Projects.				Section 1
	Part A Requirements: Due prior to project initiation.
			Dust Control / Land Disturbance / Fugitive Dust			Section 2
			Construction Activities (General Conformity Emissions Analysis)			Section 3
			New Emissions Source and Permit Applicability Review			Section 4
			Air Conditioning & Refrigerant Containing Equipment			Section 5
	Part B Requirements: Due at project conclusion or annually if multiyear project.
			Product / Chemical Use Reporting			Section 6
			Reserved for future use			Section 7
	(This part left blank)
FTC Project Compliance Guide (Air Program)							1 - 2
Section 2							Fugitive Particulate Matter (Dust) Emissions
Fugitive Particulate Matter (PM) Definition						Back to Menu
Fugitive Particulate Emissions; As defined under Colorado AQCR, means fugitive
emissions of particulate matter that are the direct or proximate result of
man's activities, (e.g., Materials left by man from development projects that
are exposed to the wind or later acted upon by another force such automobile
traffic, or particulate matter being thrown into the atmosphere by the
operation of a bulldozer, material handling operations, etc...)
Air Program Guidance / Requirements							Back to Menu
	Land Disturbance Air Permit Application(s)
	Under Colorado air quality regulations, land development refers to all
	land clearing activities, including but not limited to land preparation
	such as excavating or grading, for residential, commercial, or
	industrial development, or oil and gas exploration and production. Land
	development activities release fugitive dust, a pollutant regulated by
	the Air Pollution Control Division (Division) at the Colorado
	Department of Public Health and Environment.
	1.) For projects lasting in duration for greater than 6 months, or have
	a total disturbed area of greater than 25 acres, proponents and/or
	contractors shall submit either a Land Development Air pollution
	Emissions Notice (LD APEN) or file for project inclusion under the
	State's General Permit.
	2.) The links below provide an overview of the air pollution reporting
	and permitting requirements that may apply to land development
	activities.
		►	State Land Disturbance Permit Guidance.pdf
		►	Colorado Land Disturbance Permit Application / APEN.doc
		►	Copy of State General Permit
	ALL Construction Activities						Back to Menu
	Regardless of the fact that a project is deemed exempt from Land
	Disturbance permitting requirements by the state, all construction
	activities are subject to the following regulations and controls.
	1.) 20% opacity limit shall apply to all construction activities.
	2.) No off-property transport emission limitation guidelines shall apply.
	3.) Water and use controls as necessary to comply with the law.
FTC Project Compliance Guide (Air Program)							2 - 1
Section 2 Continued							Fugitive Particulate Matter (Dust) Emissions
	Paved Roads						Back to Menu
	Any person who through operations or activities repeatedly deposits
	materials which may create fugitive particulate emissions on a public
	or private paved roadway is required to comply with the following to
	minimize such emissions;
	1.) Gravel entryways shall be utilized to prevent mud and dirt carryout
	onto paved surfaces.
	2.) Any mud or dirt tracked out onto paved surfaces shall be cleaned up
	daily.
	Storage and Handling of Materials						Back to Menu
	Any owner or operator or any new or existing materials storage and
	handling operation from which fugitive particulate emissions will be
	emitted shall be required to comply with the following regulations and
	controls in order to minimize such emissions;
	1.) 20% opacity limit shall apply to storage and handling of materials.
	2.) No off-property transport emission limitation guidelines shall
	apply to storage and handling of materials.
	3.) Water and use controls as necessary to comply with the law.
	Haul Roads						Back to Menu
	FTC has a State enforceable				Fugitive Dust Control Plan	and a mandate
	to control emissions to the extent possible and practical from all dirt
	roads on the installation.
	1.) Contractors which contribute significantly to trip counts (> 40
	vehicles/day) along any section of the installation's dirt roads for
	hauling purposes will be required to assist in maintaining emissions
	control by watering to the extent that no nuisance emissions are
	created.
	2.) Contractors shall adhere to posted speed limits on all roads at all
	times.
	Haul Trucks
	Any owner or operator of any new or existing haul trucks from which
	fugitive particulate emissions will be emitted shall be required to;
	1.) Cover all loads when trucks are leaving the work site (work site
	is defined as the immediate construction area as defined by the permit
	or APEN application).
FTC Project Compliance Guide (Air Program)							2 - 2
Section 2 Continued							Fugitive Particulate Matter (Dust) Emissions
	Sandblasting Operations						Back to Menu
	Any owner or operator of any new or existing sandblasting activities
	from which fugitive particulate emissions will be emitted shall be
	required to;
	1.) Comply with the 20% opacity emission limitation guideline.
	2.) Use control methods inherent to the industry standards to comply
	with the law.
	Demolition Activities
	Employ watering to prevent potentially harmful construction debris and
	fine particulate matter from being transported off-site (off-site is
	defined as any property adjacent to the demolition property).
FTC Project Compliance Guide (Air Program)							2 - 3
Section 3							General Conformity
Construction Activities (General Conformity Definition)						Back to Menu
For Federal actions a Conformity Determination is required for each pollutant
where the total of direct and indirect emissions in a nonattainment or
maintenance area caused by a Federal action would equal or exceed the
applicable De Minimis or Regional Significance thresholds. 40 CFR 93.153(c)
contains actions exempt from this requirement. A Record of Non-Applicability
should be prepared for any action exempted, or where emissions are less than
the above referenced significance thresholds.
Air Program Guidance / Requirements							Back to Menu
	Conformity Reviews
	All federal actions taking place within the Colorado Springs Carbon
	Monoxide Maintenance Area (FTC Cantonment Area) must undergo a General
	Conformity Analysis.
	All planned projects, actions, and initiatives must be accurately
	captured and conveyed to the DPW-ED Air Program via the Air Quality
	Assessment (AQA) form. This information is required BEFORE the action
	begins so that the Air Program can complete the emissions analysis (if
	applicable) and document the conforming action via the Record of Non-
	Applicability (RONA), or one of the other methods as outlined in the
	reference CFR.
	1.) Complete the AQA form. General exemptions are given for common
	conforming actions, that under the law do not require an emissions
	analysis. If the form button below is disabled then based on your input
	under the general project description, a conformity review is not
	required.
	2.) Project Proponents are responsible for contacting the Air Program
	to inquire about the status of their action/project. Please allow up to
	2 weeks after submission to complete the emissions analysis.
	3.) In most cases projects will be exempt from the general conformity
	determination requirements. However the analysis must still be
	completed, and records must be maintained by the facility. In most
	circumstances this form will constitute the record of review.
FTC Project Compliance Guide (Air Program)							3 - 1
Section 3 Continued							General Conformity
FTC Project Compliance Guide (Air Program)							3 - 2
Section 4							New Source Review
New Source Review (NSR) & Prevention of Significant Deterioration (PSD)							Back to Menu
Fort Carson must manage contemporaneous changes to potential emissions from
the installation that would cause or could be defined as a major modification
under PSD, trigger New Source Performance Standards (NSPS) for a listed source
category, or require a construction permit under the states NSR rules.
Air Program Guidance / Requirements							Back to Menu
	New Stationary Sources of External Combustion (ECU)
	All new Boilers and H2O Heaters should be equipped or installed with
	certified Low NOx controls capable of reducing these exhaust gases to
	less than 30 ppm (corrected to 3% excess O2).
	For H2O Heaters with heat inputs less than 400,000 btu/hr., the unit
	must be SCAQMD Rule 1146.2 certified and produce not more than 55 ppm
	of NOx (corrected to 3% excess O2).
	Indirect Fired Make-up Air Units (MAU) should not be used on the
	installation since these units do not offer any emissions controls.
	Direct Fired MAUs may be used in limited circumstances but must be ANSI
	83.4 or Z83.18 certified.
	1.) All External Combustion Equipment installed, regardless of fuel
	type, must be reported to the DPW-ED Air Program via the equipment
	schedule portion of the Air Quality Assessment (AQA) form. This
	information is required BEFORE construction begins so that compliance,
	permitting, and modification (PSD) determinations can be made.
	New Stationary Sources of Internal Combustion (ICU) i.e. Engines						Back to Menu
	All Internal Combustion Engines, emergency or otherwise, not previously
	existing on FTC must receive an Air Emissions Construction Permit prior
	to construction (defined as foundation installation). The Engine must
	be certified by the manufacturer to the appropriate emissions control
	tier, based on the size of the unit and the date of manufacture.
	1.) All planned Internal Combustion Engines, regardless of fuel
	type and size, must be reported to the DPW-ED Air Program via the
	equipment schedule portion of the Air Quality Assessment (AQA)
	form. This information is required BEFORE construction begins so that
	Air Permit Applications can be submitted early enough to receive
	timely permits and not cause undue delay to the project
	construction schedules. ALL UNITS CURRENTLY REQUIRE A PERMIT.
FTC Project Compliance Guide (Air Program)							4 - 1
Section 4 Continued							New Source Review
	Other Stationary Sources of Criteria Pollutant Emissions						Back to Menu
	Any other sources of air pollution not specifically identified above
	must be reported to the air program for a regulatory determination.
	The determination will document the source type and the compliance
	status for the source well in advance of it's proposed operation.
	Examples of other sources include, parts washers and weapons cleaners,
	wood working shop tools, welding devices, paint booths, lab equipment,
	and any air pollution control devices to be connected to any existing or
	proposed piece of equipment.
	1.) Provide initial details on the source via the AQA form.
FTC Project Compliance Guide (Air Program)							4 - 2
Section 5							Ozone Depleting Substances
Ozone Depleting Substance & Refrigerant Containing Equipment							Back to Menu
The required production and use phase out of Class II Ozone Depleting Compounds
(ODC) requires that new HVAC equipment manufacturers must utilize Non-ODC
refrigerants for equipment manufactured after 1/1/2010. Given the useful life
of the equipment and facilities they support, Fort Carson should avoid
specifying and using any Class II substance (ex. R-22) containing equipment to
avoid potentially costly material acquisitions in the future due to supply
issues. ALL Class I (ex. R-12, Halon) refrigerants are strictly controlled by
DoD. If Class I substances are used and / or discovered contact the Air
Program immediately for the requirements!!!
Air Program Guidance / Requirements							Back to Menu
	Refrigerant Types
	HVAC equipment refrigerants should have an Ozone Depletion Potential of
	"0.0". Acceptable (HFC) refrigerant types include: R-23, R-134a,
	R-407a, b, & c, R-410a, & R-507.
	DoD policy requires that ALL Class I and pure HCFC-22 (a Class II
	substance) must remain under DoD control at all times. Class I
	substances may not be stockpiled at an installation. Any portion not
	immediately used must be turned in to the ODC Strategic reserve. Pure
	HCFC-22 may be stored for use on installations or turned in to the ODC
	reserve.
	1.) All ODS Containing Equipment installed, regardless of refrigerant
	type, must be reported to the DPW-ED Air Program via the equipment
	schedule portion of the Air Quality Assessment (AQA) form. This
	information is required so that compliance and registration
	determinations can be made.
	2.) Any and all personnel engaging in any maintenance, repair, charging,
	or re-recharging, or any other activity upon any ODC containing
	equipment must be EPA certified, maintain records, and comply with 40
	CFR parts 82 Subparts A, B, E, and F. This requirement is applicable to
	stationary and mobile assets, and is subject to enforcement under the
	Clean Air Act.			40 CFR Part 82 -- Protection of Stratospheric Ozone
	3.) All records of certification and service (other than those of KIRA)
	shall be made available to Air Program personnel upon request. Any
	records obtained will remain on site as proof of compliance.
FTC Project Compliance Guide (Air Program)							5 - 1
Section 6							Chemical & Product Use Reporting
Product Use Reporting							Back to Menu
Per condition 18.2 of the Fort Carson Title V Permit (95OPEP110), "Fort Carson
shall track emissions of Hazardous Air Pollutants (HAPs) from all insignificant
activities on a calendar year basis. Calculations shall be completed by
April 30 for the previous calendar year. For mass balance calculations, the
permit holder shall assume that the total HAP contained in the raw material
used is emitted to the atmosphere. HAP content shall be determined from the
specific Material Safety Data Sheets (MSDSs). Records of emission calculations
and the MSDS shall be maintained by the permit holder and made available to the
Division for inspection upon request. For the purposes of this condition,
insignificant activities shall be defined as any activity or equipment which
emits any amount of emissions but does not require an APEN (NOT the same as a
Land development APEN).
Air Program Guidance / Requirements
	Construction, Maintenance, Renovations, and Other Contracted Functions
	Entities engaged in activities matching the description above must
	provide Fort Carson with a detailed accounting of all materials and
	products used to accomplish the activity or task. This information
	is required to comply with the Title V Permit, and maintain an
	Area Source status for Hazardous Air Pollutant (HAP) emissions.
	For ALL Projects:
	1.) Reporting Scenario 1: Provide an MSDS for ALL products used during
	the project. Report product units and amounts used on the 1st page of
	the MSDS.
	2.) Reporting Scenario 2: Completely fill out the "Product Use" section
	of the Air Quality Assessment (AQA) form and provide the data to the Air
	Program at the conclusion of the project. The Air Program can then
	obtain a copy of the specific products' MSDS copy for our compliance
	calculations and records.
	3.) Reporting Frequency (All Scenarios): For projects starting and
	concluding within the same calendar year (CY), Part B reporting will be
	due at the conclusion of the project. Multiyear projects shall report
	Part B data annually by no later than 1/30 for each subsequent calendar
	year the project extends into, and then submit final CY data immediately
	upon conclusion of the project.
FTC Project Compliance Guide (Air Program)							6 - 1
					END

State Land Disturbance Permit Guidance.pdf Colorado Land Disturbance Permit Application / APEN.doc Copy of State General Permit Fugitive Dust Control Plan 40 CFR Part 82 -- Protection of Stratospheric Ozone Construction Activities (General Conformity Emissions Analysis) Dust Control / Land Disturbance / Fugitive Dust Air Conditioning & Refrigerant Containing Equipment Product / Chemical Use Reporting Section 1 Data Required for ALL Projects.

Construction Activities (General Conformity Emissions Analysis) Air Conditioning & Refrigerant Containing Equipment Product / Chemical Use Reporting New Emissions Source and Permit Applicability Review Product / Chemical Use Reporting Section 2 Section 3 Section 4 Section 5 Section 6 Section 1 Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Back to Menu Construction Activities (General Conformity Emissions Analysis)

		Air Quality Assessment Form - PART A REQUIREMENT
									Version 4.12-0
								Back to Instructions
		GENERAL PROJECT INFORMATION
		Please enter as complete information as possible regarding the activity.
Section 1		Project Name:
		Project Number:
		Project Description:
		Project Start Month:		Project Start Year:				Calculated Duration (days):
		Project End Month:		Project End Year:				Calculated work days:
	Sub Section 1.2: Contact Information
	Company Name:						Phone Number:
		Address 1:					Fax Number:
		Address 2:
		City, State, Zip:
	Office POC Name:						Phone Number:
		e-mail Address:
	Field POC Name:						Phone Number:
		e-mail Address:
	Sub Section 1.3: Contract Affiliation
	Contractor Type:				Explain:
		Discipline:				Explain:
			Government POC for Project Oversight:
			Government POC Phone Number:
			Type of Governement Oversight:				Explain:
	Other information:
								Back to Instructions

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	Air Quality Assessment Form - PART A REQUREMENT
										Version 4.12-0
									Back to Instructions
Section 2
	SECTION APPLICABLE?			YES:		NO:
Land Disturbance Data
Total Project Acres:								Total Acers of Disturbed Land:
				Total Acres Disturbed at Any One Time:
		Date When Earthmoving will:		Commence:				Stop:
				or, Estimated Duration:				Duration Units:
			Land Disturbance Phase Hours Allocations:				Select Allocation Type
				Phase I	Phase II	Phase III
			(Enter the distribution (%) of hours worked during each phase)				Total	0%
Other information:
									Back to Instructions

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	Air Quality Assessment Form - PART A REQUIREMENT
										Version 4.12-0
									Back to Instructions
	SECTION APPLICABLE?			YES:		NO:
Section 3
Construction Activities (General Conformity Analysis)
Sub Section 3.1: Demolition Data
Number of Structures						Start		Number of
	to be Demolished:			Size:		Date		Stories:		Duration:
	1.) Building Number:		sqft:						days:
	2.) Building Number:		sqft:						days:
	3.) Building Number:		sqft:						days:
	4.) Building Number:		sqft:						days:
	5.) Building Number:		sqft:						days:
Sub Section 3.2: Worker Trips
Total Number of Vehicles Used:					Number of Trips / Day / Vehicle:
% Vehicles that Use Diesel Fuel:					% of Vehicles that are NOT Trucks:
Average Round Trip Distance Driven (Post Gate to Worksite per Vehicle (miles):
			Worker Trip Phase Miles % Allocations:				Select Allocation Type
				Phase I	Phase II	Phase III
			(Enter the distribution (%) of trips commuted per phase)				Total	0%		0
Sub Section 3.3: Other On-Road Trips
			Total Number of 10 cuyd. Concrete Trucks Required:						Number of water truck Trips / Work Day:
			Total Number of 20 cuyd. Dump Truck Trips Required:						Total Number of Material Delivery Trucks Required:
			Total Number of 40 cuyd. Haul Truck Trips Required:
			Other / Truck Trip Phase Hours % Allocations:				Select Allocation Type
				Phase I	Phase II	Phase III
			(Enter the distribution (%) of trips made per phase)				Total	0%		0
Sub Section 3.4: Construction Equipment Specifications										Select Allocation Type
Equipment Type		Qty.	HP	Fuel	Emissions Tier	Hours (ea.)	Phase I	Phase II	Phase III
Scrapers
Graders
Dozers
Front-End Loaders
Skid Loaders
Drill/Bore Rigs
Tractor/Loader/Backhoes
Excavators
Aerial Lifts
Generators/Compressors
Trenchers
Compactors/Tampers
Pavers (conc. & asph.)
Rollers Soil (Vib.)
Rollers Soil (Comp.)
Rollers Asphalt
Other Paving Equip.
Forklifts (off road)
Cranes
Concrete Saws
Other Construction Equip.
Other information:
									Back to Instructions

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		Air Quality Assessment Form - PART A REQUIREMENT
									Version 4.12-0
								Back to Instructions
		SECTION APPLICABLE?		YES:		NO:
	NO CONSTRUCTION OR MODIFICATION OF AN EMISSION SOURCE MAY BE EXECUTED WITHOUT
	FIRST OBTAINING A PERMIT FROM CDPHE. ALL UNPERMITED SOURCES WILL SUBJECT THE REQUIRING ACTIVITY
	AND CONTRACT TO CDHE FINES AND PENALTIES.
	DPW-ENVIRONMENTAL WILL OBTAIN THE PERMIT. PLEASE PROVIDE THE REQUESTED DESIGN SPECIFICATIONS WELL IN ADVANCE OF INSTALLATION TO PREVENT PROJECT DELAY WHILE WAITING FOR A PERMIT FROM CDPHE
	Section 4
	New Source Review (New Emissions Sources)
	Sub Section 4.1: External Combustion Equipment (Boilers, Furnaces, Hot Water Heaters, etc…)
	Equipment / Emissions		Max. Heat Input	Fuel	NOx Emissions	Manufacturer	Model		Action
	Unit Type		Rating (MBtu/Hr)	Type
1
2
3
4
5
6
7
8
9
							PTE (lbs)
	Sub Section 4.2: Internal Combustion Equipment (Generators, Other Engines, etc…)
	Equipment / Emissions		Rated BHP	Fuel	Emissions	Manufacturer	Model		Action
	Unit Type			Type	Tier
1
2
3
	Sub Section 4.3: Other Equipment (select as many as apply)						If Other Please Explain:
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		Air Quality Assessment Form - PART A REQUIREMENT
									Version 4.12-0
								Back to Instructions
		SECTION APPLICABLE?			YES:		NO:
	Section 5
	Ozone Depletion (Refrigeration Equipment)
	Equipment	System Size		Refrigerant	Number	Charge	Manufacturer	Model
	Type	(Value)	(Units)	Type	of Circuits	(lbs)
1
2
3
4
5
6
7
8
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		Air Quality Assessment Form - PART B REQUIREMENT
										Version 4.12-0
									Back to Instructions
		SECTION APPLICABLE?		YES:		NO:
	Section 6
	Product Use Data
	Preparer's Name:					Submission Quarter:			Submissions Year:
Item	Product		National Stock No.		Manufacturer		Container Size	Container		Quantity
Number	Name		or Product No.					Units		Used
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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19
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	Additional Comments / Data
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Air Quality Assessment Form - RESERVED FOR FUTURE USE
		Version 4.12-0
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