TE-09p Fugitive Dust Control Form 16-Paving

Dugway Proving Ground Fugitive Dust Control Plan Form 16 Roads, Paved and Unpaved

Paving and Subgrade Preparation
Activity Description: Paving and subgrade preparation is to make a site ready for paving streets, parking lots, etc.

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 adjacent disturbed soils following paving activities BMP 16-01 Apply and maintain water on disturbed soils.
BMP 16-02 Apply and maintain chemical stabilizer on disturbed soils. (Name of chemical:

)

BMP 16-03 Stabilize disturbed soils with vegetation or hyrdoseeding. BMP 16-04 Apply synthetic cover to disturbed soils.
BMP 16-05 There are no soils adjacent to paving activities.

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-16

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