Placer County, CA

Track-out Prevention

Any visible track-out on a paved public road where vehicles enter and exit the work area must be removed at the end of the workday or at least once per day. Removal shall be accomplished by using wet sweeping or a HEPA filter equipped vacuum device. (Rule 228 Sections 304.1 and 304.2)

Select at least one additional control option that will be employed for track-out prevention: *

A gravel pad designed using good engineering practices to clean the tires of exiting vehicles
A tire shake
A wheel wash system
Pavement extending for not less than 50 consecutive feet from the intersection with the paved public road
Any other measure(s) as effective as those listed

Describe any other measure(s)

Earth-Moving & Excavation Activities

Check to show your understanding of these requirements:*

Visible Emissions not Allowed Beyond Boundary Line: A person shall not cause or allow the emissions of fugitive dust beyond the property boundary.
When wind speeds result in dust crossing the boundary line, grading and earthmoving operations shall be suspended, and inactive areas stabilized.
Dust shall not obstruct an observer’s view more than smoke that is as dark or darker in shade as than Number 2 on the Ringelmann Chart (40% opacity).
Application of water is required prior to any land clearing.

Select at least one control option for earth-moving activities:*

Pre-wetting the ground to the depth of anticipated cuts
Reduction of earth moving equipment operational speed
Any other measure as effective as those listed

Other control measure:

Control Methods for Active Storage Piles

Check all that apply:*

Keeping the surface adequately wet
Covering with tarps
Treating with a chemical dust suppressant
Any other control method that is equally effective

Describe other:

Traffic Control for On-Site Unpaved Roads, Parking Lots & Staging Areas

Check to show your understanding of these requirements*

A maximum speed limit of 15 miles per hour (mph) unless the road surface and surrounding area is sufficiently stabilized to prevent violations.
If a local jurisdiction’s Ordinance is more restrictive than the above control measure, then the Ordinance must be adhered to.

Select at least one traffic control option:*

Water every two hours during active operations or sufficiently often to keep the area adequately wet.
Apply chemical dust suppressants consistent with manufacturer’s directions.
Apply covering (please describe).
Any measure as effective as those listed.

Other measure:

Offsite Transport

Check to show your understanding of these requirements:*

Vehicles leaving the site are cleaned to prevent dust, silt, mud and dirt from being released or tracked off site.
Trucks are maintained such that no spillage can occur from holes or other openings in cargo compartments.
Loads are adequately wet.

Select at least one offsite transport option:

Covered with tarps
Wetted and loaded such that material does not touch the front, back or sides of the cargo compartment at any point less than six inches from the top

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Dust Control Form

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Project Description

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Declaration: Project Is Not in a Naturally Occurring Asbestos (NOA) Area

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Control Measures

Track-out Prevention

Earth-Moving & Excavation Activities

Control Methods for Active Storage Piles

Traffic Control for On-Site Unpaved Roads, Parking Lots & Staging Areas

Offsite Transport

District Use Only

Monitoring

Recordkeeping

Construction Emissions/Equipment Inventory

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