Fillable APPENDIX 3- ATMOSPHERIC DISPERSION MODELING CERTIFICATION CHECKOFF SHEET (North Carolina Forest Service)

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APPENDIX 3- ATMOSPHERIC DISPERSION MODELING CERTIFICATION CHECKOFF SHEET (North Carolina Forest Service)

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APPENDIX 3- ATMOSPHERIC DISPERSION MODELING CERTIFICATION CHECKOFF SHEET
APPLICANT Name: ____________________________________________
Address: ___________________________________________________
__________________________________________________________
Business Address: ___________________________________________
__________________________________________________________
County: ____________________________________________________
Email Address: ______________________________________________
Phone: _____________________________________________________
NC Forest Service Employee: Yes ____ No____ If yes, what unit (District, Region, etc.): _______
Does applicant plan to contract services for atmospheric dispersion modeling? : Yes____ No____
Certification Requirements
Date and location of Advanced Atmospheric Dispersion Modeling course successfully completed.
__________________________________________________________________________________
__________________________________________________________________________________
Model Run Evaluation #1:
a. Burn plan attached? Yes____ No____
b. Approved model used? Yes____ No____
c. Do model inputs match burn plan parameters (weather, fuels, etc)? Yes____ No____
d. Do model output show acceptable levels of PM
2.5
pollutants? Yes____ No____
Model Run Evaluation #2:
a. Burn plan attached? Yes____ No____
b. Approved model used? Yes____ No____
c. Do model inputs match burn plan parameters (weather, fuels, etc)? Yes____ No____
d. Do model output show acceptable levels of PM
2.5
pollutants? Yes____ No____
Model Run Evaluation #3:
a. Burn plan attached? Yes____ No____
b. Approved model used? Yes____ No____
c. Do model inputs match burn plan parameters (weather, fuels, etc)? Yes____ No____
d. Do model output show acceptable levels of PM
2.5
pollutants? Yes____ No____
I hereby recommend that _______________________________________________, Certified Burner
Number____________________, be certified as an Atmospheric Dispersion Modeler.
EVALUATOR Printed Name:_______________________________________________
Signature:_____________________________________________________________
Certified Burner Number:________________________________________________
Comments: ___________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Mail, Fax, or scan and email to the Fire Environment Forester. INCLUDE COMPLETE BURN PLANS AND
MODEL RUN DATA RESULTS.
Fire Environment Forester
NC Forest Service
1616 Mail Service Center
Raleigh, NC 27699-1616
(919) 857-4806 FAX
coopsrm@ncagr.gov
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APPENDIX 3- ATMOSPHERIC DISPERSION MODELING CERTIFICATION CHECKOFF SHEET (North Carolina Forest Service)

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Completed 20 July 2020

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