DAQ-2024-005226

1

DAQC-228-24
Site ID 10096 (B4)
MEMORANDUM

TO: STACK TEST FILE – SUNNYSIDE COGENERATION ASSOCIATES

THROUGH: Harold Burge, Major Source Compliance Section Manager

FROM: Robert Sirrine, Environmental Scientist

DATE: March 7, 2024

SUBJECT: Source: Circulating Fluidized Bed Combustion Boiler (EU#1)
Location: 1 Power Plant Road, Sunnyside, Carbon County, UT
Contact: Rusty Netz – 435-888-4476
Tester: Montrose Air Quality Services, LLC, Craig Kormylo 303-495-3936
FRS ID#: UT0000004900700030
Permit #: 700030005 dated March 8, 2023
Subject: Review of Pretest Protocol Dated February 16, 2024

On February 28, 2024, the DAQ received a stack test protocol for emissions testing of the Sunnyside
EU#1 located in Sunnyside, Carbon County, UT. Testing will be performed starting the week of August
6, 2024, and continue over a 30-day operating period to determine Hg emission rates and demonstrate
continuing compliance with the MATS Hg LEE requirements found in 40 CFR 63 Subpart UUUUU and
permit Conditions II.B.2.m(1)(c), II.B.2.m(4) and (5), and II.B.2.m.1(c).

PROTOCOL CONDITIONS:

1. RM 30B used to determine total vapor phase mercury emissions; OK
2. ALT -091 used to determine moisture content in lieu of RM4; OK
DEVIATIONS: None noted.

CONCLUSION: The Sunnyside Cogeneration Associates stack testing protocol for continuing
Hg LEE status testing of EU#1 has been evaluated and appears to be
acceptable.

RECOMMENDATION: Send protocol review and test date confirmation notice.

ATTACHMENT: Sunnyside Cogeneration Associates stack test protocol dated February 16, 2024.

Sunnyside Cogeneration Associates
P.O. Box 159 . Sunnyside, Utah tJ4539 . (435) 8884476 ' Fax [phone]
February 76,2024
Harold Burge
Utah Division of Alr Quality
195 North 1950 West
salt Lake city, utah 84116
I,TAH DEPARruENT OF
EIWIRONMENTAL QUATJTY
tEB 2B 2l,24
DIVISION OF AIR QUALTTV
Subject:Protocol for Mercury Stack Testing to
Demonstrate On-Going LEE status
Sunnyside Cogeneration Associates (SCA)
Dear Mr. Burge:
lncluded is SCA's Protocol for Mercury Stack Testing to Demonstrate On-GoinB (LEE) status. The
Hg testing peftains to the requirements of Utility MACI 40 CFR 63 Subpart UUUUU. SCA will continue
with an annual 30-day Hg test to demonstrate Low Emittlng EGU status (LEE). The test will begin August
6,2024,
We look forward to working with you to comply with the requirements of this regulation. lf you
have any questions or concerns please contact Rusty Netz or myself at (435) 8884476.
Thank You,Ar,-l//f
Edward McCourt
Agent for
Sunnyside Cogeneration Associates
Rusry Netz
Plant File
cc.
Source Test Plan for
2024 LEE Demonstration
Unit EU# I
Sunnyside Cogeneration Associates
Sunnyside, Utah
Prepared For:
Sunnyside Cogeneration Associates
1 Power Plant Road
Sunnyside, Utah 84539
Prepared By:
Montrose Air Quality Services, LLC
990 West 43rd Avenue
Denver, CO 80211
For Submission To:
Utah Division of Air Quality
195 North 1950 West
Salt Lake City, UT 84116
Document Number: GPO43AS-O25A22-PP-673
Proposed Test Date: August 6,2(J24
Submittal Date: July 6t 2024
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UTAH DEPARTMENT OF
ENVIRONMENTAL QUAL]TY
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DI\.'ISION OF AIR QUALIT
SrAG,k#,
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I ceftify that, to the best of my knowled
complete and accurate and conforms to
Management System and D7036-
it
}tiiSignaturez ft\tl,
the information contained in this document is
requirements of the Montrose Quality
2/L5/2024
QA/QC AnalystName:
1
Matthew Parks
I have reviewed, technically and editoriallf, details and other appropriate written materials
contained herein. I hereby certify that to frre best of my knowledge the presented material
is authentic and accurate and conforms td tne requirements of the Montrose Quality
Management System and ASTM D7036-04.
* . . )r' .,,r0" ,...1 l
sisnature | ,:-'-'.t';;' ,J9*!;r'4 o"."r 2lls/2o24
Name: Tim Wojtach I Title: Account Manager
GP043AS-025822-PP-81 1 Page 2 ot 43
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Table of Contents
"Pags
1.0 Introduction. ........ 5
1.1 Summary of Test Program .......... 5
L.2 Applicable Regulations and Emission Limits ........6
1.3 Key Personnel....... ...........7
2.0 Plant and Sampling Location Descriptions........ ......... B
2.1 Process Description, Operation, and Control Equipment..... ............8
2.2 Flue Gas Sampling Locations ........ B
2.3 Operating Conditions and Process Data...... ...............9
2.4 Plant Safety........ ......9
2.4.L Safety Responsibilities ...........9
2.4.2 Safety Program and Requirements ........10
3.0 Sampling and Analytical Procedures .....12
3. 1 Test Methods .... .. ..........t2
3.1.1 EPA Method 30B.. .........12
3.2 Process Test Methods...... .....13
4.0 Quality Assurance and Reporting..... .........t4
4.L QA Audits.. ................14
4.2 Quality Control Procedures ...........t4
4.2.1 Equipment Inspection and Maintenance...... ............14
4.2.2 Audit Samples .........L4
4.3 Data Analysis and Validation .....L4
4.4 Sample Identification and Custody .......15
4.5 Quality Statement .............15
4.6 Reporting .............15
4.6.1 Example Report Format .......16
4.6.2 Example Presentation of Test Results....... ...............17
List of Appendices
Appendix A Supporting Information.. ............18
Appendix A.1 Units and Abbreviations ...........19
Appendix A.2 Accreditation Information/Certifications..... .....27
Appendix "S" Field Work Safety Plan.. ............29
List of Tables
Table 1-1 Summary of Test Program and Proposed Schedule....... ................. 5
Proposed Test Date ........5
1r.i
GP043AS-025822-PP-8 1 1 Page 3 of 43
Table 1-2 Reporting Units and Emission
Table 1-3 Test Personnel and Responsibifities.... .......... B
Table 2-1 Sampling Location(s).......... i .......8
Table 4-1 Example <Parameter> Emissi{ns Results - Unit Name ..........L7
List of Figures
I
Figure 3-1 EPA Method 30B SampllnO Trafr ...,............13
Figure 4-1 Typical Report Format | ...............16
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GP043AS-025822-PP-81 1
lirl i i
1.O Introduction
1,1 Summary of Test Program
Sunnyside Cogeneration Associates contracted Montrose Air Quality Services, LLC
(Montrose) to perform an emissions test program at the Sunnyside Power Plant located near
Sunnyside, Utah. The tests are conducted to determine compliance with the emission limits
in 40 CFR Part 63, Subpart UUUUU.
The specific objectives are to:
. Perform annual mercury emissions testing on the exhaust stack of Unit
EU#1 over a 30-day operating period
. Conduct the test program with a focus on safety
Montrose will provide the test personnel and the necessary equipment to measure emissions
as outlined in this test plan. Facility personnel will provide the process and production data
to be included in the final report. A summary of the test program and proposed schedule is
presented in Table 1-1.
Table 1-1
Summary of Test Program and Proposed Schedule
t .: l t:'
Fiopojeo ' 0nit iD/ , ;l ,, ',;,,:;':
fi$slD.atelli l$,q,u H$Biiil$..Erf.:|q lmetery Ta$,i-i-f"th lriiiiir(;l
8/612024 : Unit 1 Hg EPA 3oB, ALT-091
lli'I
No, oJ Duration
iffi fffi r,i iii, i*,gB*st fi ( ( [
56
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GP043AS-025822-PP-81 1 Page 5 of 43
To simplify this test plan, a list of Units Abbreviations is included in Appendix A.
Throughout this test plan, chemical ature, acronyms, and repoting units are not
defined. Please refer to the list for speci details.
L.2 Applicable Regulation and Emission Limits
The results from this test program are
applicable regulations or requirements.
presented in Table 1-2.
Table 1-2
in units consistent with those listed in the
reporting units and emission limits are
Repofting Units and Emission Limits
Unit EU#1
H9
Hg
Hg
I
I lbfrBtui--
i tulew-nt
l- -{--------^----
Ii lblyr
oL.2
0.0013
29.O
IL ."J---".
GP043AS-025822-PP-8 1 1 Page 6 of 43
1.3 Key Personnel
A list of project participants is included below:
Facility Information
Source Location:Sunnyside Cogeneration Associates
Sunnyside Power Plant
1 Power Plant Road
Sunnyside, UT 84539
Rusty Netz
Environmental Advisor
Sunnyside Cogeneration Associates
[phone]xtO7
[e-mail]
Utah Depaftment of Air Quality
Rob Leishman
(801) s36-4438
[e-mail]
Project Contact:
Role:
Company:
Telephone:
Email:
Agency Information
Regulatory Agency:
Agency Contact:
Telephone:
Email:
Testing Company Information
Testing Firm: Montrose Air Quality Services, LLC
Contact: Craig Kormylo
Title: DistrictManager
Telephone: [phone]
Email: [e-mail]
GP043AS-025822-PP-8 1 1 PageT of 43
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Table 1-3 details the roles and responsibilities of the test team.
Table 1-3
Test Personnel and Responsibilities
:;;;,;;;::.:l:;:::'. |i: :a::1;aa1:::a=a.:a::: :::a ::.B$,'1, illiiililiiilltiiiiLLii.,
Field Project Manager
Technician
':::::a.::::::a: ::a:a:a:.:: ::: :l::.:=.:t :t ..':::.: . ,.:.-.;:..::.:.:..:Primary AssigrFnent '
Operate mobile lab
Execute stack platform
responsibilities
Additional Responsibilities
Facil ty interface, test crew cooldination
Preparation, support PM
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2.O Plant and Sampling Location Descriptions
2,L Process Description, Operation, and Control
Equipment
The Sunnyside Cogeneration Facility is a steam-electric generating power plant located in
Sunnyside, Carbon County, Utah. The plant consists of a circulating fluidized bed (CFB)
combustion boiler designated EU #L, an emergency backup diesel-fired PumP, diesel storage
tanks, coal handling equipment, ash handling equipment and limestone handling equipment.
EU #1hasa rating of 700 mmBtu/hrand isequipped with limestone injection and a baghouse
for control of emissions. The EU #1 is fueled by coal refuse from the Sunnyside and Star
Point Refuse Piles. The flylbottom ash generated from the coal combustion is disposed of in
an on-site landfill or used for beneficial applications.
2,2 Flue Gas Sampling Locations
Actual stack measurements, number of traverse points, and location of traverse points will
be evaluated in the field as part of the test program. Table 2-1 presents the anticipated
stack measurements and traverse points for the sampling locations listed.
Table 2-1
Sampling Location
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Unit EU#1
Sample location(s) are verified in the field to conform to EPA Method 1. Acceptable cyclonic
flow conditions are confirmed priorto testing using EPA Method 1, Section 11.4.
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2021 2
GP043AS-025822-PP-81 1 Page B of 43
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2.3 Operating Conditions and Process Data
Emission tests are performed while the source/units and air pollution control devices are
operating at the conditions required by the applicable regulation. The units are tested when
operating normally.
Plant personnel are responsible for establishing the test conditions and collecting all
applicable unit-operating data. Data collected includes the following parameters:
. Relevant CEMS data
2.4 Plant Safety
Montrose will comply with all safety requirements at the facility. The facility Client Sponsor,
or designated point of contact, is responsible for ensuring routine compliance with plant
entry, health, and safety requirements. The Client Sponsor has the authority to impose or
waive facility restrictions. The Montrose test team leader has the authority to negotiate any
deviations from the facility restrictions with the Client Sponsor. Any deviations must be
documented.
2.4.L Safety Responsibilities
Planning
. Montrose must complete a field review with the Client Sponsor prior to the
project date. The purpose of the review is to develop a scope of work that
identifles the conditions, equipment, methods, and physical locations that will
be utilized along with any policies or procedures that will affect our work
. We must reach an agreement on the proper use of client emergency services
and ensure that proper response personnel are available, as needed
. The potential for chemical exposure and actions to be taken in case of
exposure must be communicated to Montrose. This information must include
expected concentrations of the chemicals and the equipment used to identify
the substances.
. Montrose will provide a list of equipment being brought to the site, if required
by the client
Project Day
. Montrose personnel will arrive with the appropriate training and credentials
for the activities they will be performing and the equipment that they will
operate
. Our team will meet daily to review the Project Scope, Job Hazard Assessment,
and Work Permits. The Client Sponsor and Operations Team are invited to
participate.
GP043AS-025822-PP-B 1 1 Page 9 of 43
E.
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fit,
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. Montrose will provide equipment that can interface with the client utilities
previously identified in the planning phase and only work with equipment that
our client has made ready and prepared for connection
. We will follow client direction regarding driving safety, safe work permitting,
staging of equipment, and other crafts or work in the area
. As per 40 CFR Part 60 Subpart A, Section 60.8, the facility must provide the
following provisions at each sample location:
o Sampling ports, which meet EPA minimum requirements for testing. The
caps should be removed or be hand-tight.
o Safe sampling platforms
o Safe access to the platforms and test ports, including any scaffolding or
man lifts
o Sufficient utilities to perform all necessary testing
. Montrose will use the client communication system, as directed, in case of
plant or project emergency
. Any adverse conditions, unplanned shutdowns or other deviations to the
agreed scope and project plan must be reviewed with the Client Sponsor prior
to continuing work. This will include any safe work permit and hazard
assessment updates.
Completion
. Montrose personnel will report any process concerns, incidents or near misses
to the Client Sponsor prior to leaving the site
. Montrose will clean up our work area to the same condition as it was prior to
our arrival
. We will ensure that all utilities, connection points or equipment have been
returned to the pre-project condition or as stated in the safe work permit. In
addition, we will walk out the job completion with Operations and the Client
Sponsor if required by the facility.
2.4.2 Safety Program and Requirements
Montrose has a comprehensive health and safety program that satisfies State and Federal
OSHA requirements. The program includes an Illness and Injury Prevention Program, site-
specific safety meetings, and training in safety awareness and procedures. The basic
elements include:
. All regulatory required policies/procedures and training for OSHA, EPA,
FMCSA, and MSHA
. Medical monitoring, as necessary
. Use of Personal Protective Equipment (PPE) and chemical detection equipment
. Hazard communication
GP043AS-025822-PP-8 1 r Page 10 of 43
. Pre-test and daily toolbox meetings
. Continued evaluation of work and potential hazards
r Near-miss and incident reporting procedures as required by Montrose and the
Client
Montrose will provide standard PPE to employees. The PPE will include but is not limited to;
hard hats, safety shoes, glasses with side shields or goggles, hearing protection, hand
protections, and fall protection. In addition, our trailers are equipped with four gas detectors
to ensure that workspace has no unexpected equipment leaks or other ambient hazards.
The detailed Site Safety Plan for this project is attached to this test plan in Appendix "S".
GP043AS-025822-PP-81 1 Page 11 of 43
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3.1 Test Methods
The test methods for this test program have been presented in Table 1-1. Additional
information regarding specific applications or modifications to standard procedures is
presented below.
3.1.1 EPA Method 3OB
Determination of Total Vapor Phase Mercury Emissions from Coal-Fired
Combustion Sources Using Carbon Sorbent Traps
EPA Method 30B is a manual test method for measuring total vapor phase mercury (Hg)
emissions from coal-fired combustion sources using sorbent trap sampling and an extractive
or thermal analytical technique. The method includes sampling into duplicate sorbent traps,
which are analyzed using a sorbent trap mercury analyzer. This type of analyzer uses
thermal desorption with ultraviolet atomic absorption (UV AA) or ultraviolet atomic
fluorescent (UV AF) cold vapor analysis. Each trap consists of two equal-mass sections of
iodinated activated charcoal (Section 1 and 2). The results for Section 1 and Section 2 of
each tube are reported in nanograms (ng) of Hg per section, and then they are summed.
The charcoal sorbent is pre-checked to certify that mercury background levels are below the
detection limit of the laboratory instrument. Each trap is uniquely numbered, and the
sorbent batch number is printed on the outside of the glass tubes. One trap per run is pre-
spiked in the first sorbent section with a known quantity of elemental mercury, using a
proprietary gas-phase bulk spiking procedure. Each run includes two samples (A and B)
collected concurrently from a single representative sampling point in the exhaust stack
using a dual probe. Samples are drawn through the sorbent traps into a moisture knockout
loaded with desiccant, and then through a sampling orifice.
The typical sampling system is detailed in Figure 3-1.
3.O Sampling and Analytical Procedures
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Page 12 of 43GP043AS-025822-PP-B 1 1
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Figure 3-1
EPA Method 3OB Sampling Train
fTherrccouple
Healed Vaeum Line
D|H,O Sh&t
.- Vaculm Line
3,2 Process Test Methods
The applicable regulations do not require process samples to be collected during this test
program.
GP043AS-025822-PP-B 1 1
4.A Quality Assurance and Reporting
4.L QA Audits
Montrose has instituted a rigorous QA/QC program for its air quality testing. Quality
assurance audits are performed as part of the test program to ensure that the results are
calculated using the highest quality data available. This program ensures that the emissions
data we report are as accurate as possible. The procedures included in the cited reference
methods are followed during preparation, sampling, calibration, and analysis. Montrose is
responsible for preparation, calibration, and cleaning of the sampling apparatus. Montrose
will also perform the sampling, sample recovery, storage, and shipping. Approved contract
laboratories may perform some of the preparation and sample analyses, as needed.
4.2 Quality Control Procedures
Montrose calibrates and maintains equipment as required by the methods pefformed and
applicable regulatory guidance. Montrose follows internal procedures to prevent the use of
malfunctioning or inoperable equipment in test programs. All equipment is operated by
trained personnel. Any incidence of nonconforming work encountered during testing is
reported and addressed through the corrective action system.
4.2.L Equipment Inspection and Maintenance
Each piece of field equipment that requires calibration is assigned a unique identification
number to allow tracking of its calibration history. All field equipment is visually inspected
prior to testing and includes pre-test calibration checks as required by the test method or
regulatory agency.
4.2.2 Audit Samples
When required by the test method and available, Montrose obtains EPA TNI SSAS audit
samples from an accredited provider for analysis along with the samples. Currently, the
SSAS program has been suspended pending the availability of a second accredited audit
sample provider. If the program is reinstated, the audit samples will be ordered. If required
as part of the test program, the audit samples are stored, shipped, and analyzed along with
the emissions samples collected during the test program. The audit sample results are
reported along with the emissions sample results.
4.3 Data Analysis and Validation
Montrose convefts the raw field, laboratory, and process data to reporting units consistent
with the permit or subpart. Calculations are made using proprietary computer spreadsheets
or data acquisition systems. One run of each test method is also verified using a separate
example calculation. The example calculations are checked against the spreadsheet results
and are included in the final report. The"Standard Conditions"forthis project are29.92
inches of mercury and 68 oF.
G P043AS -025 822-PP -BLL Page 14 of 43
i:
4.4 Sample Identification and Custody
The on-site Field Project Manager will assume or assign the role of sample and data
custodian until relinquishing custody. The sample custodian will follow proper custody
procedures before departing from the test site including:
. Assign the unique sample identification number to each sample
. Attach sample labels and integrity seals to all samples
. Complete COC form(s), ensuring that the sample identification numbers on
the samples match the sample identification numbers on the COC
. Pack and store samples in accordance with the test method requirements in
appropriate transport containers for protection from breakage, contamination,
or loss
. Keep samples in a secure locked area if not in the direct presence of Montrose
staff
The sample custodian will follow proper custody procedures upon arriving at the Montrose
office including:
. Remove samples and COC documents from vehicles and check into
designated secure sample holding areas
. Store samples requiring additional measures such as refrigeration or dry ice
appropriately
4.5 Quality Statement
Montrose is qualified to conduct this test program and has established a quality
management system that led to accreditation with ASTM Standard D7036-04 (Standard
Practice for Competence of Air Emission Testing Bodies). Montrose participates in annual
functional assessments for conformance with D7036-04 which are conducted by the
American Association for Laboratory Accreditation (A2LA). All testing performed by Montrose
is supervised on site by at least one Qualified Individual (QI) as defined in D7036-04
Section 8.3.2. Data quality objectives for estimating measurement unceftainty within the
documented limits in the test methods are met by using approved test protocols for each
project as defined in D7036-04 Sections 7.2.7 and 12.L0. Additional quality assurance
information is included in the appendices. The content of this test plan is modeled after the
EPA Emission Measurement Center Guideline Document (GD-042).
4.6 Reporting
Montrose will prepare a final report to present the test data, calculations/equations,
descriptions, and results. Prior to release by Montrose, each report is reviewed and certified
by the project manager and their supervisor, or a peer. Source test reports will be
submitted to the facility or appropriate regulatory agency (upon customer approval) within
GP043AS-025822-PP-81 1 Page 15 of43
25 days of the completion of the field work. The report will include a series of appendices to
present copies of the intermediate calculations and example calculations, raw field data,
laboratory analysis data, process data, and equipment calibration data.
4.6.L Example Report Format
The report is divided into various sections describing the different aspects of the source
testing program. Figure 4-1 presents a typical Table of Contents for the final report.
Figure 4-1
Typical Repoft Format
Cover Page
Ceftification of Repod
Table of Contents
Section
1.0 Introduction
2.O Plant and Sampling Location Descriptions
3.0 Sampling and Analytical Procedures
4.O Test Discussion and Results
5.0 Internal QA/QC Activities
Appendices
A Field Data and Calculations
B Facility Process Data
C Laboratory Analysis Data
D Quality Assurance/Quality Control
E Regulatory Information
GPO43AS-025 822-PP -BLL Page 16 of 43
4.6.2 Example Presentation of Test Results
Table 4-1 presents the typical tabular format that is used to summarize the results in the
final source test report. Separate tables will outline the results for each target analyte and
compare them to their respective emissions limits.
Table 4-1
Example <Parameter> Emissions Results -
Unit Name
fy"cery oat:
-P1lgIF-!e-r
lr-lIre
I Oz, o/o volume dry
I l--1- -"
i
xx
xx
!
.........,.._,.s
1
I
I--.'* *4
i
ii:npJ!-r9_.111-v:_"c_::_"1"-1::_n9J9r:__ .__"_ * i**]--.-*}-."..-"]*"'
i sample duration, minutes , XX i XX ! XX : XX.**flsj.v.r*n*-ril:!e.?- -- * r "II ":"-l--r"- - l--:- *-, - -;x :*
I-* r* ..... -:.. . -- - - n
_c-oa eo vorur" dry
" __:T* i1
*
": XL -| !\ _ _
j -_;i- ,a..^ ^^^ !^--^-^!..-^ 6r f .,., i .,., 1 .,., i .,., i
XX
**-***l** ****"-'"------ - -1I flue gas temperature, oF XX I xX ] xX i xx
1
i moisture content, o/o volume 1 xx i xi : xx j xx i
GP043AS-025822-PP-8 1 1 Page 17 of 43
Appendix A
Su pportiryg f nformation
Appendix A.1
Units and Abbreviations
GP043AS-025822-PP-81 1 Page 19 of 43
60 l*?.x,I\gLE
UNITS AND ABBREVIATIONS
@X% 02 corrected to X% oxygen (corrected for dilution air)
lCCl absolute value of the confidence coefficient
ldl absolute value of the mean differencesoC degrees CelsiusoF degrees FahrenheitoR degrees Rankine
" HzO inches of water column
13.6 specific gravity of mercury
AH pressure drop across orifice meter, inches H2O
AP velocity head of stack gas, inches H2O
e total sampling time, minutes
Ug microgram
P" density of acetone, mg/ml
Pw density of water, 0.9982 g/ml or 0.00220't lb/ml
acfrn actual cubic feet of gas per minute at stack conditions
A" cross-sectional area of nozzle, ft
As cross-sectional area ofstack, square feet (ft')
Btu British thermal unit
Bm proportion by volume of water vapor in gas stream
Ca particulate matter concentration in stack gas, gr/acf
Crrg average unadjusted gas concentration, ppmv
Coi, measured concentration of calibration gas, ppmv
cf or ft3 cubic feet
cfrn cubic feet per minute
CG". average gas concentration adjusted for bias, ppmv
CM average of initial and final system bias check responses from upscale calibration gas, ppmv
cm or mt cubic meters
Cr,rr actual concentration of the upscale calibration gas, ppmv
Co average of initial and final system bias check responses from lowievel calibration gas, ppmv
Cp pitot tube coefficient
Cs particulate matter concentration in stack gas, gr/dscf
CS calibration span, % or ppmv
Cs measured concentration of calibration gas, ppmv
Cv manufactured certified concentration of calibration gas, ppmv
D drift assessment, % of span
dcf dry cubic feet
dcm dry cubic meters
Dn diameter of nozzle, inches
Ds diameter of stack, inches
dscf dry standard cubic feet
dscfm dry standard cubic feet per minute
dscm dry standard cubic meters
Fd F-factor, dscf/MMBtu of heat input
fom feet per minute
fps feet per second
feet
t( square feetg gram
gal gallons
gr grains (7000 grains per pound)
grldscf grains per dry standard cubic feel
hour
GP043AS-025822-PP-B 1 1 Page 20 of 43
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in
k
K
K3
1(4
kg
64\ l*?N,I+g[,H
UNITS AND ABBREVIATIONS
percent of isokinetic sampling
inch
kilo or thousand (metric units, multiply Uy t O3)
kelvin (temperature)
conversion factor 0.0154 grlmg
conversion factor 0.00266S ((in. Hgxft'))/((ml)('R))
kilogram
6 pitot tube constant (85.49 fUsec)
kwscfrr thousand wet standard cubic feet per hour
I liters
lb/hr pounds per hour
lb/MMBtu pounds per million Btu
lpm liters per minute
m meter or milli
M thousand (English units) or mega (million, metric units)
mt cubic meters
ma mass of residue of acetone after evaporation, mg
Md molecular weight of stack gas; dry basis, lb/lb-mole
meq milliequivalent
mg milligram
Mg megagram (106 grams)
min minute
ml or mL milliliter
mm millimeter
MM million (English units)MMBtu/hr million Btu per hour
mn total amount of particulate matter collected, mg
mol mole
mol. vvt. or MW molecular weight
Ms molecular weight of stack gas; wet basis, lb/lb-mole
MW molecular weight or megawattn number of data points
ng nanogram
nm nanometer
Pu", barometric pressure, inches Hg
pg picogram
Ps stack static pressure, inches H2O
Pm barometric pressure of dry gas meter, inches Hg
ppb parts per billionppbv parts per billion, by volumeppbvd parts per billion by volume, dry basisppm parts per millionppmv parts per million, by volumeppmvd parts per million by volume, dry basisppmvw parts per million by volume, wet basis
Ps absolute stack gas pressure, inches Hg
psi pounds per square inchpsia pounds per square inch absolutepsig pounds per square inch gauge
Psto standard absolute pressure, 29.92 inches Hg
Q" volumetric flow rate, actual conditions, acfrn
Q. volumetric flow rate, standard conditions, scfrn
Qsta volumetric flow rate, dry standard conditions, dscfrn
R ideal gas constant 21.85 ((in. Hg) (ft3)y(('R) (lbmole))
GP043AS-025822-PP-8 1 1 Paqe 21 of 43
64\ I,}?N,Iryg[,H
UNITS AND ABBREVIATIONS
SBnna post-run system bias check, % ofspan
SBi pre-run system bias check, % of span
scf standard cubic feet
scfh standard cubic feet per hour
scftn standard cubic feet per minute
scm standard cubic meters
scmh standard cubic meters per hour
sec second
sf, sq. ft., or d square feet
std standard
t metric ton (1000 kg)
T o.szs t-value
Ta absolute average ambient temperature, "R (+459.67 for English)
T, absolute average dry gas meter temperature, oR (+459.67 for English)
ton ort ton = 2000 pounds
tph or tons/hr tons per hour
tpy or tons/yr tons per year
T" absolute average stack gas meter temperature, oR (+459.67 for English)
Tsta absolute temperature at standard conditions
%
V"
vm
Vmlstol
vm
vn
vs
Vwc(sto)
Vwilstol
Vres1sto1
W
wa
W,p
Wss
Y
volt
volume of acetone blank, ml
volume of acetone used in wash, ml
total volume H2O collected in impingers and silica gel, grams
volume of gas sampled through dry gas meter, ft'
volume of gas measured by the dry gas meter, conected to standard conditions, dscf
stack gas volume sampled, acf
volume collected at stack conditions through nozzle, acf
average stack gas velocity, feet per second
volume of water vapor condensed, corrected to standard conditions, scf
volume of water vapor in gas sampled from impingers, scf
volume of water vapor in gas sampled from silica gel, scf
watt
weight of residue in acetone wash, mg
total weight of impingers, grams
total weight of silica gel, grams
dry gas meter calibration factor, dimensionless
GP043AS-025 822-PP -BlL Page 22 of 43
64\ llg,N,T\P"LH
AAS
ACDP
ACE
AD
ADL
AETB
AS
ASTM
BACT
BDL
BHP
BIF
BLS
CC
CD
CE
CEM
CEMS
CERMS
CET
CFR
CGA
CHNOS
CNCG
co
coc
COMS
CPM
CPMS
CT
CTM
cTo
CVAAS
De
DE
Dioxins
DLL
DNCG
ECD
EIT
ELCD
EMPC
EPA
EPRI
ES
ESP
EU
FCCU
FGD
FI
FIA
FID
FPD
FPM
FTIR
FTPB
FTRB
Furans
GC
ACRONYMS
atomic absorption spectroscopy
air contaminant discharge permit
analyzer calibration error, percent of span
absolute difference
above detection limit
Air Emissions Testing Body
applicable standard (emission limit)
American Society For Testing And Materials
best achievable control technology
below detection limit
brake horsepower
boiler and industrial furnace
black liquor solids
confidence coefficient
calibration drift
calibration error
continuous emissions monitor
continuous emissions monitoring system
continuous emissions rate monitoring system
calibration error test
Code of Federal Regulations
cylinder gas audit
elemental analysis for determination of C, H, N, O, and S content in fuels
concentrated non-condensable gas
catalytic oxidizer
chain of custody
continuous opacity monitoring system
condensible particulate matter
continuous parameter monitoring system
combustion turbine
conditional test method
catalytic thermal oxidizer
cold vapor atomic absorption spectroscopy
equivalent diameter
destruction efficien cy
polychlorinated dibenzo-p-dioxins (pcdd's)
detection level limited
dilute non-condensable gas
electron capture detector
Engineer ln Training
electoconductivity detector (hall detector)
estimated maximum possible concentration
US Environmental Protection Agency
Electric Power Research lnstitute
emission standard (applicable limit)
electrostatic precipitator
emission unit
fluid catalytic cracking unit
fl ue gas desulfurization
flame ionization
fl ame ionization analyzer
fl ame ionization detector
fl ame photometric detector
fi lterable particulate matter
Fou rier-transform i nfrared spectroscopy
field train proof blank
field train recovery blank
polychlorinated dibenzofurans (pcdfs)
gas chromatography
GP043AS-025822-PP-B 1 1 Page 23 of 43
60 **?,N,Tryg[,E
ACRONYMS
GC/MS gas chromatography/mass spectroscopy
GFAAS graphite furnace atomic absorption spectroscopy
GFC gas filter correlation
GHG greenhouse gas
HAP hazardous air pollutant
HC hydrocarbons
HHV higher heating value
HPLC high performance liquid chromatography
HRGC/HRMS high-resolution gas chromatography/high-resolution mass spectroscopy
HRSG heat recovery steam generator
lC ion chromatography
ICAP inductively-coupled argon plasmography
ICPCR ion chromatography with a post-column reactor
ICP-MS inductively coupled plasma-mass spectroscopy
lR infrared radiation
ISO lnternational Standards Organization
kW kilowatts
LFG landfill gas
LHV lower heating value
LPG liquified petroleum gas
MACT maximum achievable control technology
MDI methylene diphyenyl diisocyanate
MDL method detection limit
MNOC maximum normal operating conditions
MRL method reporting limit
MS mass spectrometry
NA not applicable or not availableNCASI National Council For Air And Steam lmprovement
NCG non-condensable gases
ND not detectedNDIR non-dispersive infraredNESHAP National Emissions Standards For Hazardous Air Pollutants
NG natural gas
NIOSH National lnstitute For Occupational Safety And Health
NIST National lnstitute Of Standards And Technology
NMC non-methane cutterNMOC non-methane organic compounds
NMVOC non-methane volatile organic compoundsNPD nitrogen phosphorus detector
NSPS New Source Performance Standards
OSHA Occupational Safety And Health Administration
PAH polycyclic aromatic hydrocarbons
PCB polychlorinated biphenyl compounds
PCWP plywood and composite wood products
PE Professional Engineer
PFAS per- and polyfluoroalkyl substances (PFAS)
Pl photoionization
PID photoionization detector
PM particulate matter
PMro particulate matter less than 10 microns in aerodynamic diameter
PMz.s particulate matter less than 2.5 microns in aerodynamic diameter
POM polycyclic organic matter
PS performance specification
PSD particle size distributionPSEL plant site emission limits
PST performance specification testPTE permanent total enclosure
PTM performance test method
GP043AS-025822-PP-B 1 1 Page 24 of 43
6C l*?,N,T+p"[,8
ACRONYMS
QtuQC quality assurance and quality control
Ql Qualified lndividual
QSTI Qualified Source Testing lndividualRA relative accuracyRAA relative accuracy auditRACT reasonably available control technologyRATA relative accuracy test auditRCTO rotary concentrator thermal oxidizerRICE stationary reciprocating internal combustion engineRM reference method
RTO regenerative thermal oxidizerSAM sulfuric acid mist
SCD sulfur chemiluminescent deteclorSCR selective catalytic reduction systemSD standard deviationSemi-VOST semivolatile organic compounds sample trainSRM standard reference materialTAP toxic air pollutant
TBD to be determinedTCA thermal conductivity analyzerTCD thermal conductiMty detectorTGNENMOC total gaseous non-ethane non+nethane organic compoundsTGNMOC total gaseous non-methane organic compoundsTGOC total gaseous organic compoundsTHC total hydrocarbonsTIC tentatively identified compoundTO thermal oxidizerTO toxic organic (as in EPA Method TO-15)TPM total particulate matterTSP total suspended particulate matterTTE temporary total enclosureULSD ultra-low sulfur dieselUV ultraviolet radiation rangeVE visible emissionsVOC volatile organic compoundsVOST volatile organic sample trainWC water column
\ /WTP waste water treatment plant
GP043AS-025822-PP-8 1 1 Page 25 of 43
Ag
As
Ba
Be
c
cd
cds
60 s?sIryp"Lr
Ni
NO
Noz
Nor
o2
Clz
cl02
co
Co
CO,
Cr
Cu
H2
HrO
CHEMICAL NOMENCLATURE
silver
arsenic
barium
beryllium
carbon
cadmium
cadmium sulfide
CH2O formaldehyde
CH3CHO acetaldehyde
CH3OH methanol
CHo methane
C2H4O ethylene oxide
CzHe ethane
CaH4O acrolein
CaH6O propionaldehyde
CeHe propane
C6H5OH phenol
chlorine
chlorine dioxide
carbon monoxide
cobalt
carbon dioxide
chromium
copper
EtO ethylene oxide
EtOH ethyl alcohol (ethanol)
hydrogen
water
HuOz hydrogen peroxide
HrS hydrogen sulfide
H2SO4 sulfuric acid
HCI hydrogen chlorideHg mercuryIPA isopropyl alcoholMDI methylene diphyenyl diisocyanate
MeCl2 methylene chloride
MEK methyl ethyl ketone
MeOH methanolMn manganese
nitrogen
ammonia
nickel
nitric oxide
nitrogen dioxide
nitrogen oxides
oxygen
P phosphorus
Pb lead
PCDD polychlorinateddibenzo.pdioxins
PCDF polychlorinated dibenzofurans
Sb antimony
Se
SO,
Sos
SO,
TCDD
TCDF
TGOC
THC
TI
TRS
Zn
selenium
sulfur dioxide
suffur trioxide
sulfur oxides
tetrachlorodibenzod ioxin
tetrach lorodibenzofu ran
total gaseous organic concentration
total hydrocarbons
thallium
total reduced sulfur compounds
zinc
N2
NHs
GP043AS-025822-PP-81 1 Page 26 of 43
Appendix A.2
Accred itation I nformation / Ce rtifications
ffi Americon Associotio n f or Loborotorv Accreditotion
Accredited Air Emission Testing Body
A2LA hos occredited
MONTROSE AIR QUALITY SERVICES
ln recognition of ihe successful completion of the joint A2LA ond Stock Testing Accredilotion Council (STAC)
evoluolion process, this loborolory is occrediied to perform testing ociivities in complionce wilh
ASTM D7035:2004 - Stondord Prociice for Competence of Air Emission Testing Bodies.
Vice President, Accreditotion Services
For the Accreditotion Council
Certificoie Number 3925.0 1
Volid to Februory 29,2024
Th.is accred.itation program. is not includcd under the A2LA ILAC Mutual Recognition Arrongement.
GP043AS-025822-PP-81 1 Paqe 28 of 43
Presenied this 4th doy of Februory 2022
Appendix r\S"
Field Work Safety Plan
I
I
ffiffiq &ne#MY.eer}*6e
'Wu f ' AI{a ntu,Airtry $ilRVs{ rq;
I
I
I
I
SITE SAFEry PLAN BOOKLET
I
I
Glient Project
Revision Date: January 21,2022
GP()43AS-025822-PP-811 Page 30 of 43
.#fo" .L t L ./;'{ ." t i.};
Page 1 of 2
Site Safety Plan and JHA Purpose and lnstructions
Purpose
Employee safety is the top priority of Montrose Environmental Group. All employees must be
trained to assess and mitigate hazards. The District Manager and Project Manager are
responsible to ensure all hazards have been properly identified and managed. All employees
have Stop Work Authority in all situations where an employee feels they or their co-worker
cannot perform a job safely or if there is a task for which they have not been adequately trained.
The Site Safety Plan (SSP) has been developed to help assist Montrose test crews with
identifying physical and health hazards and determining how the hazards will be managed.
Additionally, the SSP will help each crew manage the safety of the employees by providing
emergency procedures and information. The booklet contains a severalsafety forms that may
be required in the field.
lnstructions
The SSP consists of the following:
1. A Pre-Mobilization Test Plan - To be completed in it's entirety by the client project Manager
prior to the test.
2. A Job Hazard Analysis is a standardized, two-page, fillable form that is used to evaluated the
tasUsite's particular hazards and controls. The form also includes a daily toolbox topic and
daily hazard review with sign off by the team. The client Project Manager is responsible to
complete the JHA form through section B. Upon arrival at the test site, the team will review the
form for accuracy, making any corrections required and complete the remainder of the JHA.
Section 9 will require at least three tasks, hazards and controls be identified for the project.
Each team member has the option to discuss making changes or adding to the JHA and must
sign on the Job Hazard Analysis form in agreement and sign in Section 10. The JHA is to be
modified when conditions change. A toolbox meeting with a daily topic in addition to a review of
the hazard analysis is required daily for the duration of the test. An additional sheet of paper
with the toolbox topic and signatures can be added to the SSP packet.
3. Hazard Control Matrix - contains useful information on both engineering and
administrative controls that a crew can use to reduce or eliminate the hazards they have
observed plus applicable PPE that may be required.
4. Emergency Action Plan - The Job Supervisor/ Client Project Manager (CPM) will complete
the Emergency Action Plan form and ensure that allemployees are familiar with the facility
emergency and evacuation procedures, assembly/ rally points, alert systems, and signals prior
to work commencing. ln the event of an emergency situation/ evacuation, the Job Supervisor/
CPM will maintain a roster and be responsible for accounting for all employees. The Job
Supervisor/ CPM will ensure that this Emergency Action Plan Form is completed,
communicated to all employees, signed, and posted.
5. Additional Forms, as applicable
a. MEWP Lift lnspection Form
b. Heat Stress Prevention Form Based on Heat Index
c. Extended Hours Form
AQS-FRM-1.13R1
Page 31 of 43GP043AS-025822-PP-81 1
Page2 of2
AQS-FRM-1.13R1
Page 32 of43
Purpose and lnstructions
ger should continually update their SSPs as
hazards are presented.
the Test Plan in the office for a period of 3
for the Site Safety Plans.
tI
&V,c &qL.${\ & }dLJ}H
I4W ' ;ri r,.\ r. ,'i ' rl j,. f ,
I
Site Safety Plan ano .lln
The SSP is a living document. The Project $ana
new information and conditions change or ifkrew
I
Each completed SSP should be maintainedfwith
years. There will be an audit process develfOed
GPO43AS-025822-PP -8LL
PROJ ECT NAME/LOCATION :
TEST DATE:
PROJECT #:
PROJECT MANAGER:
TEST SCOPE:
SITE CONTACT: Name:Contact Phone:
; ;<;zo a.ia I ita.,,*,: [,
Page 1 of 2
PRE.MOBILIZATION TEST I NFORMATION
$gglSe fypei New Source: _ Revisit: _ Prj#/Date/Tech:
Coal Fired Electric Utility: _ Ethanol Plant: _ Chemical Mfg. of
CemenULime Kiln Plant: _ Specialty Mfg. of:Other:
Anticipated Effluent Composition - check all that apply and fill in expected concentration in ppm/%
tr
voc
Toxic: Corrosive: Dust:
trtr
CO NOx
tr
other
lf other, explain:
Flammable:
Engineering Controls to be lmplemented:
tr
SOz
Additional Safety Equipment Required :
Personal gas monitors: _
Respiratory Protection:
Half Face_ Full Face_ HEPA Filters_ Supplied Air: _ (Safety Dept. Approval)
Approximate Flue Gas Temperatures, (F)
below 210 210 to 450 450 to 950 above 950 other
lf other, explain:
Approximate Duct Pressure, (iwg):
-3 -3 to +3 +3 to +7
trtr tr
above
tr
+7 other
lf other,
AQS-FRM-1.17
tr
u
below
explain: _
GP043AS-025822-PP-8 1 1 Page 33 of 43
,.":.,i ,1,1(l+o"" E !.'" J r,
M
Page 2 of 2
PRE.MOBILIZATION TEST I N FORMATION
Sampling Location: Stack Port _ Duct Port _
Approximate Sampling Platform Height, (ft)
tr
100 other
lf other, explain:
Access and Protection:
Elevators: _ Ladders: _ MEWP Lift: _ Scaffold: _ Equipment Hoist: _
Guardrails: _ Toe plate: _ Engineered Tie Off Points: _ Heat Shield: _
Other:
Describe how equipment will be mobilized to the sampling location:
trtrtr
below 6 6 to 50 50 to 100
tr
above
Additional Information:
Effluent Chem ical Requlatorv Limits
Gas Name Ghemical
Formula
Gal OSHA PELI
(ppm)
Cal OSHA
STEL2
{ooml
NIOSH REL
TWA3 (ppm)
Cal OSHA
Ceiling
{ooml
IDLHl
{ppm}
3arbon Monoxide CO 25 200 35 200 1,200
Nitric Oxide NO,25 ND5 25 ND 100
Sulfur Dioxide SOz 2 5 2 ND 100
Hvdroqen Chloride HCI 0.3 2 ND 2 50
Hydrogen Sulfide HzS 10 15 10 (10 min.)c 50 100
)alifomia Occupational Safety and Health Administmtion (OSHA) Permissible Exposure Limit (PEL) based on an $-hour shift;
2: Cal OSHA Shott-term Exposure Limit (STEL) based on a lSminute peiod;
3: National lnstitute for O@upational Safety and Health (NIOSH) Recommended Exposure Limit (REL) Time-weighted Average (TWA) based
on an 8-hour shift;
4: lmmediately Dangerousto Life or Heafth (IDLH);
5: Not Defined (ND);
C: Ceiling Limit - Maximum allowable human exposure limit fu an aiftome or gaseous subsfarrce, which is not to be exceeded, even
momentaily.
Prepared by:
Reviewed by:
Date:
Date:
AQS-FRM-1.17
GP043AS-025822-PP-8 1 1 Page 34 of 43
lient lontact Name )ate
=acility SSP Writer )M
3lient Rep I
Job Preparation
[ .lou Site Walk Through Completed tr
! Sate Work Permit Received from Client
-J
Site Specific Training Complete
lf the heat index is expected to be above 91', fill out the Heat Stress Prevention Form.
Job Hazard Analysis
Risk
E rime Pressure E Remote Work Location E > 12 hr shift [ Wo*ing > 8 consecutive days
E u"t of procedures E E*tr"r" temps, wind >30mph E Personal illnessffatigue LJ vague work guidane
E Monotonous Aciivity E rirst day back after time off E tvtuttipte job locations E Other:
PPE E Hard Hats ! Safety Glasses lSafety Toe Shoe/Boot I Hearing Protection lSafety Spotter
E Hi-Vis Vests E Harness/Lanyard* E Goggles E Personal Monitor Type:
E Metatarsal Guards EI Hot Gloves E Face Shield E Respirator Type:
E Nomex/FRC E Other PPE:
1of3
'{;Ri:
l1
2.
3.
4.
AQS-FRM-1.18
Page 35 of 43
acility lnformation/Emergency Preparedness
lf non-emergency medical attention is needed, call: AXIOM #:,877-502-9466.
Plant Emergenry # Certified First Aid Person:
EMS Location Evacuation Routes Rally Point
Severe Weather Shelter Location Eye Wash & Safety Shower Location
Operational: EYes ENo
lnformation : (list type):
Stack Gas Temp. ("F) Stack Gas Press. ("H2O) Stack Gas Components:
Stack Gas lnhalation Potential? EYes E t'to tf ves, see List of Hazard Chemicats.
Hazards
Dust Hazards
Thennal:Burn
Electrical Hazards
lnadequate Lighting
Slip and Trip
Hand Protection
Secondary Permits
Working from Heights
S€e also Sect 7
Eleclrical
Lifting
Respiratory
See also Sect. 8
Hazards for Consideration
Hazard Controls
E Dust Mask E Goggles E Other:
E HotGloves DHeatshields EOther:ProtectiveClothing:
E Connections Protecied from Elements n External GFCI E Other:
E Xe nating Requirement E lntrinsically Safe Requirement
E lnstall Temporary Lighting E Headlamps
I Housekeeping E Barricade Area E Other:
E Cut Resistant Gloves E pincn ms. El cen;;f D eearicat I tmpact Resistant
fl other:
E Hotwork E Confined Space ! Excavation
f] Falling objects E Fall protection E Drop zone protec{ion f] Phtform load ratings
I ScattotO inspection E Ladder inspedion E Barricades for equipment
E Exposed wire/connector ! Verity equipment grounding f] Arc Flash
fl Crane lift plan E Rigging inspection E fag lines used El noists in place
E Unexpected exposure E Chemical E Dust (combustible) ! PEL provided
E Cartridoes or suoolied air available E Gas detection
GP043AS-025822-PP-B 1 1
@" i',- ;'"" '] s \ ;\i
Additional Work Place Hazards
Job Hazard Analysis 2of3
6.ritical Procedures - check all that apply - *indicates additional form must be completed or collected from client
E Heat Stress Prevention" fl Confined Space* fl MEWP- E Roof Work fl Scaffoto
ECotoWeatherWork IHazardousEnergyControf f]ExposureMonitoring EOther:
From Heights
Fall Protection
Falling Objects Proteclion
Fall Hazard Communication
![ fixea Guardrails/Toe boards E fatt Prevention PPE Warning Line System
i E e"nioOing tr Netting ! House Keeping flTethered Tools O Catctr Blanket or Tarp
D AdjacenUOverhead Workers ! Contractor Contact E Client Contac{
Other Considerations
Environmental Hazards - Weather Forecast
E HeaVCold ELigntning E Rain E Snow E lce E Tornado ! wind Speed
Steps for Mitigation:
Electrical Safety Planning
Plant Hook up: n t tov D 22OD4OV E aaov E cenerator E nard wired into panel
Electrical Classified Area: EYes fl No Trailer Grounded: E Yes E tlo Plug Type
Electrical Hook Up Responsibility:
List of Hazardous Chemicals
E Acetone fl Nitric Acid
Other Chemacals:
E Hydrogen Peroxide E Compressed Gases
D Hexane Esufuric Acid El lsopropyl Alcohol I Fhmmable Gas
E Toluene fl Hydrochloric Acid E liquia Nitrogen l-l Non-Flammable Gas
E Hzs E carbon Monoxide
Steps for Mitigation:
lildlife/Fauna in Area
E Poison tuy flPoison oak Elnsects:!Wildlife:
Personnel M known allergies to bees stings or other allergens? ! Yes Eruo
8.
Hazards and Mitigation Steps
1
2
3
1
2
3
1
2
3
'l
2
3
1
2
3
1
2
3
1
2
3
1
2
3
AQS-FRM-1.18
Page 36 of 43GP043AS-025822-PP-8 1 1
Job Hazard Analysis
10
3of3
JHA REVIEW: Crew Names & Signatures
Printed Name Siqnature Date Printed Name Signature Date
Dailv JHA Meetinq & Review
Items to review:
o Change in conditions r Extended work hours r Daily Safety Topic
o New workers or contractors r Occurrence of near misses or injuries
Initialing demonstrates that site conditions and hazards have not changed from the original SSP. lf changes did occur, make the
updates to this JHA and add notes as applicable in Section 9.
Day Discussion Topic lnitials
2
3
4
5
6
7
8
9
10
11
AQS-FRM-1.1
Page37 of 43GP043AS-025822-PP-81 1
lra
,! iitt..,.. "t ),\t \ r" I i \ t i ". i. .j .: g
g:/2
Poge 1 ol 2
EMERGENCY ACTION PLAN FORM
The Job Supervisor/ Client Project Manager (CPM) will ensure that all employees are familiar with the facility emergency and evacuation
prooedures, assembly/ rally points, alert systems, and signals prior to work commencing. ln the event of an emergency situation/
evacuation, the Job Supervisor/ CPM will maintain a roster and be responsible for accounting for all employees. The Job Supervisor/
CPM will ensure that this Emergency Action Plan Form is completed, communicated to all employees, and posted.
-Eou must follow the client's emergency action plan first, and notify your Supervisor immediately,
.lf incident is life threatening, CALL 911 IMMEDIATELLY
.E non-em€rgency medical attention is needed, call AXIOM Medical number: 877-502-9466.
AQS-FRM-1.11
GP043AS-025822-PP-8 1 1
1 MEG Job Supervisor/ CPM's Name:
2 MEG Job Supervisor/ CPM's Telephone Number:
3 MEG Job Safety Superuisor (if applicable):
4 MEG Job Safety Supervisor's Telephone Number:
5 Plant's Emergency Telephone Number:
6 Local Hospital/ Clinic Telephone Number:
7 Emergency Ops Radio Ghanne!:
8 Plant's #1 Gontact Person's Name:
9 Plant's #1 Contact Person's Telephone Number:
10 Plant's #2 Contact Person's Name:
11 Plant's #2 Contact Person's Telephone Number:
12 Designated Assembly Point Location:
13 Evacuation Routes:
14 Severe Weather Shelter Location:
15 Eye Wash and Safety Shower Location:
16 The First Aid Kit is Located:
17 The Fire Extinguisher is Located:
Page 38 of 43
I Facility Name:
2 Facility Alamr (Circle) :YES or NO
3
Alarm Tones:
CHEMTCAL/ GAS:.
SHELTER-IN-PLACE:
OTHER:
4 Designated Shelter(s) Description:
5 Designated Assembly Point(s) Description:
N
* JLoY
S
EMERGENCY ACTION PLAN FORM AND EVACUATION ASSEMBLY MAP REVIEW: Crew Names and Signatures
Printed Nome:Signature:Ddte:Printed Nome:Siqnature:Date:
AQS-FRM-1.11
GP043AS-025822-PP-B 1 1
EMERGENCY EVACUATION AND ASSEMBLY MAP
Poge 2 ol 2
Page 39 of 43
Page 1 of 1
Daily MEWP Lift lnspection Form
All checks must be completed prior to each work shift, before operation of the MEWP lift. This checklist must be used
atthe beginning of each shift or following 6 to 8 hours of use.
MEWP Lift Model #:Serial Number:
Make:Rented or Owned:
. Check "Yes" if an item is adequate, operational, and safe.. Check "No" to indicate that a repair or other corrective action is required prior to use.. Check'N/A" to indicate "Not Applicable."
Items to be lnspected
1. All MEWP lift components are in working condition (i.e. no loose or missing parts, torn or
loose hoses, etc.) - if something can be easily loosened by hand then it is not sufficient.
2. Hydraulic fluid level is sufficient, with the platform fully lowered
3. Hydraulic system pressure (see manufacturer specs) is acceptable.
lf the pressure is low, determine cause and repair in accordance with accepted procedures
as outlined in service manual.
4. Tires and wheel lug nuts (for tightness)
5. Hoses and cables (i.e. worn areas or chafing)
6. Platform rails and safety gate (no damage present)
7. Pivot pins secure
8. Welds are not cracked and structural members are not bent or broken
9. Warning and instructional labels are legible and secure, and load capacity is clearly marked.
10. Manufacturer's lnstruction Manual is present inside the bucket
1 1. Base controls (switches and push buttons) can be properly operated
'12. Platform conditions are safe (i.e. not slippery)
13. Fire extinguisher is present, mounted and fully charged, located inside the bucket
'14. Headlights, safety strobe light and back-up alarm are functional
15. Workplace is free of hazards (overhead powerlines, obstructions, level surface, high winds,
etc.) *Do not operate if winds are 20 mph, unless otherwise specified by manufacturcr
recommendations.
Yes
n
tr
tr
tr
n
n
tr
u
!
!
n
tr
!
n
tr
trtr
No N/A
DD
trtr
trtr
trtr
D!
trtr
trtr
trtr
trtr
Dtr
trD
trtr
trtr
tr D
Operator Name & Signature Location Date
Ground Control Name & Signature Location Date
Harness lnspections:
Printed Name Signature Date
Printed Name Signature Date
Printed Name
GP043AS-025822-PP-B 1 1
Date
AQS.FRM-1.16
Page 40 of 43
Signature
at):
r.ad " i)lc ii" r er,ti.lu-ff),A' | 'Page 1 of 1
Extended Hours Safety Audit
Project Number:Date:Time:
When a project is expected to extend past a 14-hour work day, this form must be completed to evaluate
the condition of the crew, and the safety of the work environment.
Permission to proceed into extended work hours must come from a District Manager (DM) or Regional Vice
President (RVP). Technical RVPs can authorize moving forward, if they are in the field or if they are
managing the project.
1. Hold test crew meetinq Test crew initials:
. Temperature and weather . Hoisting. Lighting . PPE (i.e. respirators, etc.)
. Working from Heights . Pollutant concentration in ambient air (SOz,
HzS, ect.)
Notifv DM or RVP
The PM must contact either the DM or RVP to discuss the safety issues that may arise due to the
extended work period. lf the DM is the acting PM on the job site, they must contact the RVP.
During this time, they can come to an agreement on how to proceed. ltemsto discuss include:
a
a
I
a
Reason for extended hours
Reason for delay
Production limitations
lmpending Weather
Contact the client
The PM, DM or RVP must discuss with client any identified safety concerns, the client's needs and
mutually agree on how to proceed. Discussion should also include the appropriate rest period
needed before the next day's work shift can begin. The DM and/or a RVP must be informed on the
finaldecision.
FinalOutcome:
Approver:
2.
3.
OOlAS-SAFEry-FM-3
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The test leader should look for signs of the following in their crews:
. lnitability. Lack of motivation. Headaches. Giddiness
. Fatigue. Depression
o Reduced alertness, lack of concentration and
memory
The test leader should assess the environmental and hazardous concerns:
GP043AS-025822-PP-81 1
1.
2.
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Heat Stress Prevention Form
This form is to be used when the Expected Heat lndex is above 91' F, and is to be kept with project
documentation.
Proiect Manaoer (PM):Exoected Hioh Temo:
Date(s):Exoected Heat lndex:
Review the signs of Heat Exhaustion and Heat Stroke
lf Heat lndex is above 91' F:. Provide cold water and/or sports drinks to allfield staff (avoid caffeinated drinks and energy
drinks which can increase core temperature).
o Bring no less than one gallon of water per employee. lf employee(s) are dehydrated, on blood pressure medication or not acclimated to heat,
ensure they are aware of the heightened risk for heat illness. Provide cool head bands/vests/etc.. Have ice available to employees. lmplement work shift rotations and breaks, particularly for employees working in direct
sunlight.. Provide as much shade at the jobsite as possible, including tarps, tents or other acceptable
temporary structures.. PM should interview each field staff periodically to evaluate for signs of heat illness
lf Heat lndex is above 103" F:. Employees must stop for drinks and breaks every hour (about 4 cups/hour). Employees are not permitted to work alone for more than one hour at a time without a
break offering shade and drinks. Employees should wear cool bands and vests if working outside more than one hour at a
time. PM should interview each field staff every 2 hours to evaluate for signs of heat illness
3.
OOlAS-SAFEry-FM-s
Page 42 of 43GP043AS-025822-PP-81 1
This is the Last Page of This Document
If you have any questions, please contact one of the following
individuals by email or phone.
Name: Craig Kormylo
Title: District Manager
Region: USA - Stack - Great Plains - Operations
Email: [e-mail]
Phone: [phone]
Name: Glen Capra
Title: Vice President
Region: USA - Stack
Email : [e-mail]
Phone: [phone]
LTTAH DEPAHTMENT OF
ENVIRONMENTAL OUAJTY
FEB 28 20?4
DIVISION OF AIR QUALITY
GPO43AS-025822-PP-8 1 1 Page 43 of 43