TE-09l Fugitive Dust Control Form 12-Disturbed Land

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: [email protected]

Environmental Programs
Air Quality Program

FDCP-12

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