PROJECT IDENTIFICATION
Project Name
Legal Name/Company
Description of the location of the project; such as Address and major cross roads
City
NAME
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
Project CUP #
PROJECT CONTACTS
In order to comply with the requirements of Regulation VIII all contacts responsible for the submittal
and implementation of the Dust Control Plan shall be identified below with an explanation of the
responsibility of each contact. If additional space is needed please attach a sheet.
(Rule 801, subsection F.2.c.1)
TITLE
PHONE NUMBER
E-MAIL ADDRESS
Describe the association the named person above has to the identified project. What are that person's
duties, responsibilities. Does the person named above have the primary responsibility for
implementing the Dust Control Plan? Is this person responsible for the project site?
NAME TITLE
PHONE NUMBER
E-MAIL ADDRESS
Describe the association the named person above has to the identified project. What are that person's
duties, responsibilities. Does the person named above have the primary responsibility for
implementing the Dust Control Plan? Is this person responsible for the project site?
Contact name
Contact Phone
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
Please identify any known contractors, names, phone contact person etc., hired to work on the
project site on separate cover.
REGULATION VIII - Rules 800-805
Page 1 of 14
Fax (442) 265-1799
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PROJECT CONSTRUCTION OPERATIONS
Project Name
Project CUP #
Provide pertinent information concerning the projects construction operations - include a plot plan
(which may be a tract map, site map or topographic map) which identifies the boundaries of the project,
existing roads (including but not limited to paved, unpaved road ways, highways and freeways), where
new proposed roads will be constructed, where the staging areas will be located, easements, entry and
exit points (include whether these entry points will be permanent or temporary), whether or not
sensitive receptors are adjacent to the project (including but not limited to residential areas, schools,
day cares, churches, hospitals, nursing facilities, commercial and/or retail), include the distance
between the project and the sensitive receptors and any other information as to allow for the proper
evaluation of dust generating point sources and their impact. (Rule 801, subsection F.2.c.2&5)
The following checklist is provided solely as a guide and is not meant to be all inclusive. During the
Plot Plan review process the Air District may identify additional dust generating point sources. For
those instances where additional sources, not listed, have been identified please list under other. (Rule
801 subsection F.2.c.2&5)
List all identified actual and potential sources of fugitive dust emissions
Bulk material handling and storage areas.
Paved and unpaved access roads, haul roads, traffic areas, and equipment storage yards.
Exit points where carryout and trackout onto paved public roads may occur.
Water supply locations if water application will be used for controlling visible dust emissions.
Check or list the relative locations of sensitive receptors within ¼ mile of the project.
(Rule 407, Nuisance)
No sensitive receptors within ¼ mile of the project.
Residential areas, schools, day care, churches, hospitals, nursing facilities, commercial, retail, etc.
Freeways, roads, or traffic areas that may be affected by the dust generating activities.
Other list below.
Other list below.
Page 2 of 14
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
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Project Name
Project CUP #
DISTURBED SURFACE AREA
Report the total area of land surface to be disturbed, the daily throughput volume of earthmovement in
cubic yards and the total area in acres of the entire project site.
(Rule 801, subsection F.2.c.3&4)
Total surface area to be disturbed
Acres
Daily maximum throughput volume of earthmoving
Cubic Yards
Daily average throughput volume of earthmoving
Cubic Yards
Total area of project site
Acres
Total disturbed areas left inactive for more than seven days
Acres
EXPECTED CONTRUCTION START AND END DATES
Phase 1 End Date
Phase 1 Start Date
Phase 2 Start Date
Phase 2 End Date
IF CONSTRUCTION IS NOT PHASED SIMPLY INCLUDE THE START AND END
DATES UNDER THE PHASE 1 OPTION
Phase 3 Start Date
Phase 3 End Date
Phase 4 Start Date
Phase 4 Start Date
Identify whether any other locations should be included with this plan that are involved with this project.
An example may include listing any site where materials will be imported from or exported to.
OTHER SITES
No other locations are included with this project
Location 1:
No Dust Control Plan Required Included with this plan Included with another plan
Location 2:
No Dust Control Plan Required Included with this plan Included with another plan
Location 3:
No Dust Control Plan Required Included with this plan Included with another plan
DUST GENERATING ACTIVITY DATES
Page 3 of 14
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
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MINIMUM REQUIREMENTS
Project Name
Project CUP #
This section describes the minimum requirements for limiting visible dust emissions from activities
that cause fugitive dust emissions. Each category must have one requirement check marked.
(Rule 801 section F) For Enhanced Measures check all that apply.
Structural Demolition
No demolitions are planned for this project explain below.
Asbestos NESHAP notification has been submitted to the ARB and copy to the District.
Pre-Activity (Rule 801 subsection F.1.a)
Not applicable for this project explain below.
The site will be pre-watered and work will be phased to reduce the amount of disturbed surface area at any
one time. (Complete section M-1 beginning with page 7)
Active Operations (Rule 801, subsection F.1.b)
Application of water or Chemical Stabilizers to earthmoving activities. (Complete sections M-1 and/or M-2)
Construct & maintain wind barriers to limit visible dust emissions to 20%. (Complete section M-3)
Temporary stabilization: areas unused for seven or more days (Rule 801 subsection F.1.c)
Not applicable for this project explain below.
Vehicular access will be restricted and water or dust suppressants will be applied and maintained at all
unvegetated areas.
(Complete sections M-2 and/or section M-3)
Date notification submitted
Page 4 of 14
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
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Unpaved Access, Haul Roads, Traffic & Equipment Storage Areas (Rule 805)
Not applicable for this project explain below.
Apply water or dust suppressants to unpaved haul and access roads.
(Complete sections M-1 and/or M-2)
Method of restricting unauthorized vehicle access.
(Complete section M-3)
Water or dust suppressants will be applied to vehicle traffic and equipment storage areas. (Complete sec M-1 and/or M-2)
Establish vegetation on all previously disturbed areas .(Complete section M-3)
MINIMUM REQUIREMENTS CONTINUED
Project Name
Project CUP #
This section describes the minimum requirements for limiting visible dust emissions from activities
that cause fugitive dust emissions. Each category must have one requirement check marked.
(Rule 801 section F) For Enhanced Measures check all that apply.
Outdoor Handling of Bulk Materials
(Rule 802)
No bulk materials will be handled during this project explain below.
Water or dust suppressants will be applied when handling bulk materials.
(Complete sections M-1 and/or M-2)
Protection from wind erosion by sheltering or enclosing the operation and transfer line. (Complete section M-3)
Outdoor Storage of Bulk Materials (Rule 802)
No bulk materials will be stored during this project explain below.
Water or dust suppressants will be applied to storage piles.
(Complete sections M-1 and/or M-2)
Storage piles will be covered with tarps, plastic or other suitable material and anchored in such a manner that
prevents the cover from being removed by wind action. (Complete section M-3)
Page 5 of 14
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
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Enhanced Measures: According to Regulation VIII stabilization must be met at all times. See Rule 801 subsection D.2
Cease dust generating activities when wind speeds exceed 25mph. (Records of wind speeds and wind gusts must be
maintained and provided to the APCD upon request.)
Application of water or dust suppressants once per hour when wind speeds exceed 15mph. (Records of wind speeds and
wind gusts must be maintained and provided to the APCD upon request.)
Apply water to maintain 12% soil moisture content when wind speed exceeds 15mph. (Records of wind speeds and wind
gusts must be maintained and provided to the APCD upon request.)
Construct fences 3-5 feet high with 50% or less porosity in conjunction with water application or dust
suppressant when wind speeds exceed 15mph. (Records of wind speeds and wind gusts must be maintained and provided to the
APCD upon request.)
OTHER - If necessary attach separate sheet.
On-Site/Off Site Transporting of Bulk Materials
No bulk materials will be transported on the project site explain below.
Haul trucks will be covered with a tarp or other suitable cover.
(Complete section M-5)
All haul trucks will be loaded such that the freeboard is not less than six inches when transported across any
paved public access road. (Complete section M-5)
Cargo compartments are maintained so that no spillage and loss of bulk material will occur from holes or other
openings in the floor, side and/or tailgate. (Complete section M-5)
Cargo compartment is to be cleaned and/or washed at delivery site after removal of Bulk Material. (Complete section
M-5)
MINIMUM REQUIREMENTS CONTINUED
Project Name
Project CUP #
This section describes the minimum requirements for limiting visible dust emissions from activities
that cause fugitive dust emissions. Each category must have one requirement check marked.
(Rule 801 section F) For Enhanced Measures check all that apply.
Page 6 of 14
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
CLEAR FORM
PRINT FORM
Project Name
Project CUP #
WATER APPLICATION
Complete this section if water application will be used as a control method for limiting visible dust
emissions and stabilizing surface areas. Check and answer all sections that apply to this project. In
addition, if there is no intention of applying water to any phase of the project explain below. (Rule 801 section F)
NO WATER APPLICATION - EXPLAIN?
WATER APPLICATION SUPPLY - THE LOCATION OF EACH MUST BE IDENTIFED ON THE PLOT PLAN
Fire hydrants
Number of hydrants available On-Site Off-Site
Approval granted by the owner or public agency to use their fire hydrants for this project.
Owner or Agency granting approval
Contact Name and phone number
Storage tanks
Number of tanks
Wells
Number of wells
Canal, River, Pond, Lake etc.
Approval granted by the owner or public agency to use their water source for this project
Other explain
Capacity of each
Flow rate of each well
Owner or Agency granting approval
Contact Name and phone number
Page 7 of 14
SECTION M-1
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
CLEAR FORM
PRINT FORM
Project Name
Project CUP #
WATER APPLICATION CONTINUED
Complete this section if water application will be used as a control method for limiting visible dust
emissions and stabilizing surface areas. Check and answer all sections that apply to this project. In
addition, if there is no intention of applying water to any phase of the project explain above.
(Rule 801 section
F)
WATER APPLICATION EQUIPMENT: THE LOCATION OF EACH MUST BE IDENTIFED ON THE PLOT PLAN
Sprinklers
Describe the activities that will utilize sprinklers
Minimum treated area
Square Feet
Acres
Maximum treated area
Water Truck
Other explain
Describe the activities that will utilize the equipment
Number of application equipment to be used
Application equipment capacity
Application frequency must be once per day or more explain frequency below
Hours of operation
Water application equipment is available to operate after normal working hours, on weekends and holidays
Name of contact after hours Phone No.
Name of contact after hours Phone No.
Frequency
Square Feet
Acres
Frequency
Page 8 of 14
SECTION M-1 CONTINUED
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
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Project Name
Project CUP #
DUST SUPPRESSANT PRODUCTS
Complete this section if a dust suppressant product will be used. These materials include but are
not limited to: hygroscopic suppressants (road salts), adhesives, petroleum emulsions, polymer
emulsions and bituminous materials (road oils).
Not Applicable - The only control method will be the application of water (Complete section M-1)
Application Area; Explain where the dust suppressant will be applied below
Product (Manufacturer) Name
Name of contractor
Phone No.
Explain the rate of application including the amount of gallons of undiluted material per mile or per acre
below.
Utilizing the checklist below attach each of the following pieces of information that fully describes the product to
be used. All information must be submitted with this plan.
Product Specifications. (MSDS, Product Safety Data Sheet, etc.)
Manufacturer's Usage Instructions. (method, frequency and intensity of application)
Environmental impacts and approvals or certificaitons related to the appropriate and safe use for ground
application.
Explain the application frequency; type and number of equipment; capacity including the amount of gallons
of undiluted material per mile or per acre below.
Check here if more than one dust suppressant will be utilized and include the necessary copies of this page
with the information for each dust suppressant to be used.
Page 9 of 14
SECTION M-2
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
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Project Name
Project CUP #
OTHER DUST CONTROL METHODS
Check below all other types of dust control methods that will be employed at the construction site.
Physical barriers for restricting unauthorized vehicle access
Fences Gates
Posts
Berms
Concrete Barriers
Other explain below
Wind barriers describe below.
Re-establish vegetation for temporarily stabilizing previously disturbed surfaces explain below.
Apply Gravel- for the application of gravel identify where application will occur such as haul road, access
roads, equipment storage yards (areas), vehicle traffic areas etc explain below.
Apply pavement - explain where paving will occur.
Other explain below.
Page 10 of 14
SECTION M-3
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
Project Name
Project CUP #
TREATMENTS FOR PREVENTING TRACKOUT
Select the control devices that will be used for preventing trackout from occurring onto paved public
roads. Trackout is any material that adheres to vehicle tires and is deposited onto a paved public road
or the paved shoulder of a paved public road. Check all that apple to this project below.
Grizzly: Rails, pipes, or grates used to dislodge debris off of vehicles before exiting the site. Extends from
the intersection with the paved public road surface for the full width of the unpaved exit surface for a
distance of at least 25 feet. Describe below
Gravel Pad: A layer of washed gravel at least three (3) inches deep which extends from the intersection
with the public paved road surface for the full width of the unpaved exit surface for a distance of at least 50
feet. Identify gravel size in inches, the pad width in feet, including the length and depth of the gravel below.
Paved Surface: Extends from the intersection with the paved public road surface for the full width of the
unpaved access road for at least 50 feet to allow mud and dirt to drop off of vehicles before exiting the site.
Identify the width and length of the paved surface below in feet.
Mud and dirt deposits within an urban area shall be cleaned immediately when trackout or carryout extends
a cumulative distance of 50 linear feet or more otherwise clean up must be at the end of the workday.
Wheel Washer: Uses water to dislodge debris from tires and vehicle undercarriage. If utilizing a wheel
washer describe the location, type and operation of the wheel washer below.
Other - describe any other measure utilized to prevent trackout below.
Page 11 of 14
SECTION M-4
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
Project Name
Project CUP #
TREATMENTS FOR PREVENTING CARRYOUT
Report the required treatments that will be used for preventing carryout from occurring on paved public
roads. Carryout occurs when materials from emptied or loaded haul trucks, vehicles, or trailers fall onto
a paved public road or paved shoulder of a paved public road. Check all that apply.
No haul trucks will be routinely entering or leaving the project site explain below.
Emptied Haul Trucks:
Interior cargo compartments will be cleaned before leaving the project site. Explain below how emptied haul
truck will be washed and the source of the water supply.
Cargo compartment will be covered with a tarp or suitable cover before leaving the project site.
Loaded Haul Trucks:
Haul trucks will be loaded such that the freeboard is not less than six inches.
Other describe below.
Spillage or loss of materials from holes or other opening(s) in the cargo compartment will be prevented when
material transported onto any paved public access road.
Page 12 of 14
SECTION M-5
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
CLEAR FORM
PRINT FORM
Project Name
Project CUP #
Check and report below the methods and frequency for cleaning up carryout and trackout from the
surface and paved shoulder of paved public roads. All material tracked or carried out onto paved road
must be removed. Check all that apply.
The use of blower devices, or dry rotary brushers or brooms, for removal of carryout and
trackout from paved public roads is not recommended.
The project is located in
An Urban Area
Minimum cleanup frequency will be at the end of the workday and removed immediately if carryout and
trackout, extends beyond 50 feet.
Optional - Clean up Method
Manually sweeping and picking up.
Mechanical sweeping with a rotary brush or broom accompanied or preceded by water.
Describe types of equipment that will be used.
CLEANING UP CARRYOUT AND TRACKOUT
Identify the urban area by location, description etc. below.
Non Urban Area
At the end of the workday
Identify the non urban area by location, description etc. below.
Page 13 of 14
SECTION M-6
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
CLEAR FORM
PRINT FORM
I certify that all information contained herein and information submitted in the attachments to these
documents are true and correct.
Print Name
Title
Signature
Date
Phone Number
Fax Number
Cell Number
Records and/or any other supporting documents used for the demonstration of compliance must be
maintained for two years and provided to the Air Pollution Control District upon request.
Project Name
Project CUP #
RECORD KEEPING
CERTIFICATION
Page 14 of 14
AIR POLLUTION CONTROL DISTRICT
CONSTRUCTION
DUST CONTROL PLAN
SAMPLE FORMAT
150 S. 9th Street, El Centro, CA 92243
Ph. (442) 265-1800
REGULATION VIII - Rules 800-805
Fax (442) 265-1799
Is this plan an original or revision?
CLEAR FORM
PRINT FORM
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