DAQ-2024-010474

1

DAQC-973-24
Site ID 10237 (B4)

MEMORANDUM

TO: STACK TEST FILE – PAFICIFICORP ENERGY – Hunter Power Plant

THROUGH: Harold Burge, Major Source Compliance Section Manager

FROM: Paul Morris, Environmental Scientist

DATE: September 26, 2024

SUBJECT: Location: Hunter Power Plant, Castle Dale, Carbon County, Utah
Contact: Jay Howard: 435-748-6519
Tester: Montrose Air Quality Services: 303-495-3936
Source: Units 1-3
FRS ID #: UT0000004901500101
Permit# Title V operating permit 1500101004 dated September 4, 2020, revised
November 19, 2021
Subject: Review of Pretest Protocol dated September 11, 2024

On September 24, 2024, the Utah Division of Air Quality (DAQ) received a protocol for testing of the
PacifiCorp Energy Hunter Power Plant Units 1-3, located in Castle Dale, Utah. Testing will begin
October 31, 2024, to determine 30 day Hg emission rates of Units 1-3 in accordance with Title V Permit
Conditions II.B.2.k and II.B.3.h.

PROTOCOL CONDITIONS:

1. RM 1 used to determine sample velocity traverses: OK
2. RM 2 used to determine stack gas velocity and volumetric flow rate: OK
3. RM 30B used to determine mercury emissions: OK

DEVIATIONS: No deviations were noted.

CONCLUSION: The protocol appears to be acceptable.

RECOMMENDATION: Send protocol review and test date confirmation notice.

ATTACHMENT: Test protocol dated September 11, 2024.

6 , 3
Hunter Plant
1000 South Highway l0
P.O. Box 569
Castle Dqle. UT 84513
September 11,2024
Mr. Bryce Bird, Director
State of Utah
Division of Air Quality
Department of Environmental Quality
P. O. Box 144820
Salt Lake City, Utah 84114-4820
Attn: Rob Leishman
Notification of PacifiCorp's Hunter Plant Unit's l, 2 & 3 Low Emitting
Electrical Generating Unit Qualification Annual Testing
Dear Mr. Bird:
The Hunter plant is scheduling a 30-boiler operating day mercury (Hg) ernission rate test to
determine if Units 7,2 &,3 continue to qualiff as a low emitting electrical generating unit
(LEE). The testing will be conducted in accordance with 40 CFR Part 63, Subpart UUWU.
The testing is scheduled to begin October 31,2024.
Re:
Should
6519 or
Managing Director
Enclosure: EPA Method 30-B Test Protocol
yoy have any questions or concerns, please contact Mr. Jay Howard at (435'y 748-
b at [phone].
'1--r---
(
Youn Joo Kim - EPA Region VIII w/enclosure
Terry Guthrie - Hunter Plant w/enclosure
Craig Kormylo - Emissions Measurement Company w/o enclosure
Tom Wiscomb - NTO Suite 210 w/o enclosure
DEPANTMENT OF
ENVIHONMENTAL OUALITY
sEP 2 4 2024
DIVISION OF AIR OUALITY
?,,wRflmm
DIVISION OFAIR OUALITY
Source Test Plan for
Annual 2fJ24 Compliance Testing
Units l, 2 and 3
PacifiCorp
Hunter Power Plant
Castle Dale, Utah
Prepared For:
PacifiCorp
L4O7 W North Temple, Suite 210
Salt Lake City, Utah 84116
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-O36892-PP-915
Proposed Test Date: October 3Lt 2024
EltioD4tM MoNr+PsF STAE
I certify that, to the best of my knowledge, the information contained in this document is
complete and accurate and conforms to the requirements of the Montrose Quality
Management System and ASJ{ D7O36-04.t 1 /\l
Signature:
Name:
Date:9/LU2024
Title:QA/QC Analyst
I have reviewed, technically and editorially, details and other appropriate written materials
contained herein. I hereby certify that to the best of my knowledge the presented material
is authentic and accurate and conforms to the requirements of the Montrose Quality
Management System and ASTM D7O36-O4.
9/LL/2024
Name:Tim Wojtach Title:Account Manager
GP043AS-036892-PP-9 1 5 Page 2 of 43
1.0
2.O
Table of Contents
Paoe
Introduction...... ........ 5
1.1 Summary of Test Program ........... 5
L.2 Applicable Regulations and Emission Limits ........6
1.3 Key Personnel...... ............7
Plant and Sampling Location Descriptions............. ............. B
2.1 Process Description, Operation, and Control Equipment........... ,............8
2.2 Flue Gas Sampling Locations .............9
2.3 Operating Conditions and Process Data...... ....................9
2.4 Plant Safety...... ....................9
2.4.1 Safety Responsibilities ........9
2.4.2 Safety Program and Requirements ............11
Sampling and Analytical Procedures......... ............12
3.1 Test Methods............ ......L2
3.1.1 EPA Method 308 ......... .......t2
3.2 Process Test Methods.......... .........13
Quality Assurance and Repoftin9........... .........L4
4.L QA Audits. ......L4
4.2 Quality Control Procedures .............. 14
4.2.L Equipment Inspection and Maintenance .........L4
4.2.2 Audit Samples ,............14
4.3 Data Analysis and Validation .................14
4.4 Sample Identification and Custody ......,...15
4.5 Quality Statement ........,.......15
4.6 Reporting ......15
4.5.1 Example Report Format .....16
4.6.2 Example Presentation of Test Resu|ts.............. .......L7
3.0
4.0
List of Appendices
Appendix A Suppofting 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
GP043AS-036892-PP-9 1 5 Page 3 of 43
Table 1-2 Reporting Units and Emission Limits ..............5
Table 1-3 Test Personnel and Responsibilities.... ............. B
Table 2-1 Sampling Location(s)......... ............9
Table 4-1 Example <Parameter> Emissions Results - Unit Name ,.,,.....L7
List of Figures
Figure 3-1 EPA Method 30B Sampling Train .........13
Figure 4-1 Typical Report Format ..............16
GP043AS-036892-PP-9 1 5 Page 4 of 43
1.O Introduction
1.1 Summary of Test Program
PacifiCorp contracted Montrose Air Quality Services, LLC (Montrose) to perform an
emissions test program at the Hunter Power Plant located in Castle Dale, Utah. The tests
are conducted to determine compliance with the applicable UDEQ permit.
The specific objectives are to:
. Perform annual mercury emissions testing on the exhaust stacks of Units 1,
2 and 3 over 30-day operating periods.
. 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 repoft. 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
EPA 3OB, ALT-091tol3Ll2024
to/3t12024 EPA 3OB, ALT-091
EPA 30B, ALT-091to/3u2024
GP043AS-036892-PP-91 5 Page 5 of 43
To simplify this test plan, a list of Units and Abbreviations is included in Appendix A.
Throughout this test plan, chemical nomenclature, acronyms, and reporting units are not
defined. Please refer to the list for specific details.
1.2 Applicable Regulations and Emission Limits
The results from this test program are presented in units consistent with those listed in the
applicable regulations or requirements. The reporting units and emission limits are
presented in Table 1-2.
Table 1-2
Repofting Units and Emission Limits
Units 1 - 3
40 CFR Part 63, Subpart UUUUU
(Low Emitting EGU Limit)
40 CFR Part 63, Subpart UUUUU
(Low Emitting EGU Limit)
40 CFR Part 63, Subpart UUUUU
(Low Emitting EGU Limit)
Page 6 of 43GP043AS-036892-PP-9 1 s
1.3 Key Personnel
A list of project participants is included below:
Facility Information
Source Location:
Project Contact:
Role:
Company:
Telephone:
Email:
Agency Information
Regulatory Agency:
Agency Contact:
Telephone:
Email:
PacifiCorp Hunter Power Plant
State Highway 10
Castle Dale, Utah 84513
Tom Wiscomb
Sr. Environmental Advisor
PacifiCorp
[phone]
Tom. Wiscom b@ pacificorp. com
Utah Depaftment of Air Quality
Rob Leishman
(801) s36-4438
[e-mail]
Jay Howard
Sr. Environmental Analyst
PacifiCorp
(43s) 748-6sL9
Jay. Howa rd @ Pacifi Corp. com
Testing Company Information
Testing Firm: Montrose Air Quality Seruices, LLC
Contact: Craig Kormylo
Title: DistrictManager
Telephone: [phone]
Email: [e-mail]
GP043AS-036892-PP-91 5 Page 7 of 43
Table 1-3 details the roles and responsibilities of the test team.
Table 1-3
Test Personnel and Responsibilities
Facility interface, test crew coordination
Preparation, support PMExecute stack platform
responsibilities
2.O Plant and Sampling Location Descriptions
2.1 Process Description, Operation, and Control
Equipment
The Hunter Plant comprises three pulverized coal-fired boilers. Hunter Unit #1 is a dry-
bottom, tangentially-fired boiler rated at 480 gross megawatts (GMW) and equipped with a
fabric-filter baghouse for particulate matter (PM) control and a flue gas desulfurization
(FGD) scrubber for sulfur dioxide (SOz) control. Hunter Unit #2 is a dry-bottom,
tangentially-fired boiler rated at 480 GMW and equipped with low-NO, burners and ovefire
air for nitrogen oxides (NO,) control, a fabric filter baghouse for PM control and an FGD
scrubber for SOz control. Hunter Unit #3 is a dry-bottom, wall-fired boiler rated at 495
GMW and equipped with low-NO" burners and overfire air for NO* control, a fabric filter
baghouse for PM control and an FGD scrubber for SOz control. In accordance with
Conditions II.B.2 and II.B.3 of Utah Department of Environmental Quality (UDEQ)
Operating Permit 1500101004, the Unit #1, Unit #2 and Unit #3 exhaust stacks are
equipped with Continuous Emission Monitoring Systems (CEMS) to quantify carbon dioxide
(COz), SOz and NOx emissions. Units 1, 2 and 3 are equipped with CEMS to quantify carbon
monoxide (CO) emissions for comparison to UDEQ permit limits.
GP043AS-036892-PP-9 1 5 Page 8 of 43
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(s)
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.
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
identifies the conditions, equipment, methods, and physical locations that will
be utilized along with any policies or procedures that will affect our work
GP043AS-036892-PP-9 1 5 Page 9 of 43
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 peforming 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.
. 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 repoft 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
GP043AS-036892-PP-9 1 5 Page 10 of 43
. 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
. Pre-test and daily toolbox meetings
. Continued evaluation of work and potential hazards
. 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-036892-PP-9 1 5 Page 11 of 43
3.O Sampling and Analytical Procedures
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.
GP043AS-036892-PP-9 1 5 Page 12 of 43
Figure 3-l
EPA Method 3OB Sampling Train
$ike SorbmtT ftt**
3.2 Process Test Methods
The applicable regulations do not require process samples to be collected during this test
program.
GP043AS-036892-PP-9 1 s Page 13 of 43
4.O Quality Assurance and Reporting
4.1 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 performed 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 paft 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 converts the raw field, laboratory, and process data to repofting 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.
GP043AS-036892-PP-9 1 5 Page 14 of 43
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 superuised on site by at least one Qualified Individual (QI) as defined in D7036-04
Section 8.3.2. Data quality objectives for estimating measurement uncertainty within the
documented limits in the test methods are met by using approved test protocols for each
project as defined in D7036-04 Sections 7.2.1and 12.10. 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 ceftified
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-035892-PP-9 1 5 Page 15 of 43
25 days of the completion of the field work. The repoft 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.
4.6.1 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
Page
ftification of Repoft
of Contents
1.0
2.0
3.0
Introduction
Plant and Sampling Location Descriptions
Sampling and Analytical Procedures
Test Discussion and Results
Internal QA/QC Activities
.0
5.0
ces
B
C
D
E
Field Data and Calculations
Facility Process Data
Laboratory Analysis Data
Qua lity Assurance/Quality Control
Regulatory [nformation
GP043AS-036892-PP-9 1 5 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
Date XX xx XX XX
Time xx XX XX XX
Process Data
parameter 1, units XX XX xx XX
parameter 2, units XX XX XX xx
Sampling & Flue Gas Parameters
sample duration, minutes xx XX XX XX
Oz, o/o volume dry XX XX XX XX
COz, o/o volume dry XX xx XX xx
flue gas temperature, oF XX XX XX XX
moisture content, o/o volume XX XX xx XX
volumetric flow rate, dscfm XX xx xx XX
<Parameter)
ppmvd XX XX XX xx
ppmvd @ 15olo Oz xx XX xx XX
tblhr xx xx XX XX
tons/yr XX XX XX XX
lblMMBtu XX xx XX XX
GP043AS-035892-PP-91 5 Page L7 of 43
Appendix A
Supporting Information
Appendix A.1
Units and Abbreviations
6 lYl?,N,T+g[E
@x%02
lccl
tdtoc
oF
oR
" Hzo
13.6
AH
AP
0
pg
Pa
P*
acfm
An
As
Btu
B6
ca
Cnrs
Co',
cf or ft3
cfm
Cc""
cM
cm or m3
Cr',lo
co
cp
cs
CS
cs
CV
D
dcf
dcm
Dn
Ds
dscf
dscfm
dscm
Fd
fpm
fps
ft
ft2
I
gal
gr
gr/dscf
hr
UNITS AND ABBREVIATIONS
corrected to X% oxygen (conected for dilution air)
absolute value of the confidence coefficient
absolute value of the mean differences
degrees Celsius
degrees Fahrenheit
degrees Rankine
inches of water column
specific gravity of mercury
pressure drop across orifice meter, inches H2O
velocity head of stack gas, inches H2O
total sampling time, minutes
microgram
density of acetone, mg/ml
density of water, 0.9982 g/ml or 0.002201 lb/ml
actual cubic feet of gas per minute at stack conditions
cross-section al area ol nozzle, ft'
cross-sectional area of stack, square feet (ft')
British thermal unit
proportion by volume of water vapor in gas stream
particulate matter concentration in stack gas, gr/acf
average unadjusted gas concentration, ppmv
measured concentration of calibration gas, ppmv
cubic feet
cubic feet per minute
average gas concentration adjusted for bias, ppmv
average of initial and final system bias check responses from upscale calibration gas, ppmv
cubic meters
actual concentration of the upscale calibration gas, ppmv
average of initial and final system bias check responses from low-level calibration gas, ppmv
pitot tube coefficient
particulate matter concentration in stack gas, gr/dscf
calibration span, % or ppmv
measured concentration of calibration gas, ppmv
manufactured certified concentration of calibration gas, ppmv
drift assessment, % of span
dry cubic feet
dry cubic meters
diameter of nozzle, inches
diameter of stack, inches
dry standard cubic feet
dry standard cubic feet per minute
dry standard cubic meters
F-factor, dscf/MMBtu of heat input
feet per minute
feet per second
feet
square feet
gram
gallons
grains (7000 grains per pound)
grains per dry standard cubic feet
hour
GP043AS-036892-PP-9 1 s Page 20 of 43
6/i\I*?N,T+gP.H
I
in
k
K
K3
&
kg
Kp
kwscfh
I
lb/hr
lb/MMBtu
lpm
m
M
m3
ma
Md
meq
mg
Mg
min
ml or mL
mm
MM
MMBtu/hr
mn
mol
mol. wt. or MW
Ms
MW
n
ng
nm
E'I bar
ps
Ps
P.
ppb
ppbv
ppbvd
ppm
ppmv
ppmvd
ppmvw
Ps
psi
psia
psig
Psta
Q"
o"
Qsto
R
UNITS AND ABBREVIATIONS
percent of isokinetic sampling
inch
kilo or thousand (metric units, multiply Oy t03)
kelvin (temperature)
conversion factor 0.0154 gr/mg
conversion factor 0.002668 ((in. Hg)(ftr))/((mlX'R))
kilogram
pitot tube constant (85.49 fUsec)
thousand wet standard cubic feet per hour
liters
pounds per hour
pounds per million Btu
liters per minute
meter or milli
thousand (English units) or mega (million, metric units)
cubic meters
mass of residue of acetone after evaporation, mg
molecular weight of stack gas; dry basis, lb/lb-mole
milliequivalent
milligram
megagram (106 grams)
minute
milliliter
millimeter
million (English units)
million Btu per hour
total amount of particulate matter collected, mg
mole
molecular weight
molecular weight of stack gas; wet basis, lb/lb-mole
molecular weight or megawatt
number of data points
nanogram
nanometer
barometric pressure, inches Hg
picogram
stack static pressure, inches H2O
barometric pressure of dry gas meter, inches Hg
parts per billion
parts per billion, by volume
parts per billion by volume, dry basis
parts per million
parts per million, by volume
parts per million by volume, dry basis
parts per million by volume, wet basis
absolute stack gas pressure, inches Hg
pounds per square inch
pounds per square inch absolute
pounds per square inch gauge
standard absolute pressure, 29.92 inches Hg
volumetric flow rate, actual conditions, acfm
volumetric flow rate, standard conditions, scfm
volumetric flow rate, dry standard conditions, dscfm
ideal gas constant 21.85 ((in. Hg) (ft3)y(("R) (lbmole))
GP043AS-036892-PP-9 1 5 Page 21 of 43
6 l!t?N,I+gp.H
SBnn"t
SB,
scf
sclh
scfm
scm
scmh
sec
sf, sq. ft., or ft2
std
t
T o.grs
T"
T.
ton or t
tph or tons/hr
tpy or tons/yr
Ts
T"to
V,"
Vm(std)
vr"
vs
Vwc(std)
Vwi(sta)
Vmglsto;
W
w"
Wirp
Wss
UNITS AND ABBREVIATIONS
post-run system bias check, % of span
pre-run system bias check, % of span
standard cubic feet
standard cubic feet per hour
standard cubic feet per minute
standard cubic meters
standard cubic meters per hour
second
square feet
standard
metric ton (1000 kg)
t-value
absolute average ambient temperature, oR (+459.67 for English)
absolute average dry gas meter temperature, oR (+459.67 for English)
ton = 2000 pounds
tons per hour
tons per year
absolute average stack gas meter temperature, oR (+459.67 for English)
absolute temperature at standard conditions
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, corrected to standard conditions, dscf
stack gas volume sampled, acf
volume collected at stack conditions through nozzle, act
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-036892-PP-9 1 5 Page 22 of 43
l
64\ l,l?N,I+gp.E
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
D,
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 moniloring 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 efficiency
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
flame ionization detector
flame photometric detector
fi lterable particulate matter
Fourier-transform inf rared spectroscopy
field train proof blank
field train recovery blank
polychlorinated dibenzofurans (pcdf s)
gas chromatography
GP043AS-036892-PP-9 1 5 Page 23 of 43
6A M?N,I+ST.H
GC/MS
GFAAS
GFC
GHG
HAP
HC
HHV
HPLC
HRGC/HRMS
HRSG
IC
ICAP
ICPCR
ICP-MS
IR
rso
KW
LFG
LHV
LPG
MACT
MDI
MDL
MNOC
MRL
MS
NA
NCASI
NCG
ND
NDIR
NESHAP
NG
NIOSH
NIST
NMC
NMOC
NMVOC
NPD
NSPS
OSHA
PAH
PCB
PCWP
PE
PFAS
PI
PID
PM
PMro
PMz.s
POM
PS
PSD
PSEL
PST
PTE
PTM
ACRONYMS
gas chromatography/mass spectroscopy
graphite furnace atomic absorption spectroscopy
gas filter correlation
greenhouse gas
hazardous air pollutant
hydrocarbons
higher heating value
high performance liquid chromatography
high-resolution gas chromatography/high-resolution mass spectroscopy
heat recovery steam generator
ion chromatography
inductively-coupled argon plasmography
ion chromatography with a post-column reactor
inductively coupled plasma-mass spectroscopy
infrared radiation
lnternational Standards Organization
kilowatts
landfill gas
lower heating value
liquified petroleum gas
maximum achievable control technology
methylene diphyenyl diisocyanate
method detection limit
maximum normal operating conditions
method reporting limit
mass spectrometry
not applicable or not available
National Council For Air And Steam lmprovement
non-condensable gases
not detected
non-dispersive infrared
National Emissions Standards For Hazardous Air Pollutants
natural gas
National lnstitute For Occupational Safety And Health
National lnstitute Of Standards And Technology
non-methane cutter
non-methane organic compounds
non-methane volatile organic compounds
nitrogen phosphorus detector
New Source Performance Standards
Occupational Safety And Health Administration
polycyclic aromatic hydrocarbons
polychlorinated biphenyl compounds
plywood and composite wood products
Professional Engineer
per- and polyfluoroalkyl substances (PFAS)
photoionization
photoionization detector
particulate matter
particulate matter less than 10 microns in aerodynamic diameter
particulate matter less than 2.5 microns in aerodynamic diameter
polycyclic organic matter
performance specifi cation
particle size distribution
plant site emission limits
performance specifi cation test
permanent total enclosure
performance test method
GP043AS-036892-PP-9 1 5 Page 24 of 43
64\ lY"{?.N,T+gp.E
ACRONYMS
QtuQC quality assurance and quality controlQl Qualified lndividual
QSTI Qualified Source Testing lndividual
RA relative accuracyRAA relative accuracy auditRACT reasonably available control technologyRATA relative accuracy test audit
RCTO rotary concentrator thermal oxidizerRICE stationary reciprocating internal combustion engineRM reference method
RTO regenerative thermal oxidizerSAM sulfuric acid mistSCD sulfur chemiluminescent detectorSCR selective catalytic reduction system
SD standard deviationSemi-VOST semivolatile organic compounds sample trainSRM standard reference material
TAP toxic air PollutantTBD to be determinedTCA thermal conductivity analyzerTCD thermal conductivity detectorTGNENMOC total gaseous non-ethane non-methane organic compoundsTGNMOC total gaseous non-methane organic compoundsTGOC total gaseous organic compoundsTHC total hydrocarbonsTIC tentatively identified compoundTO thermal oxidizer
TO 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 compounds
VOST volatile organic sample trainWC water columnWWTP waste water treatment plant
GP043AS-036892-PP-9 1 5 Page 25 of 43
64\ l+?,N,I+gLE
CHEMICAL NOMENCLATURE
Ag
As
Ba
Be
C
Cd
CdS
silver
arsenic
barium
beryllium
carbon
cadmium
Se
SO,
Sog
SO,
TCDD
TCDF
TGOC
THC
TI
TRS
Zn
selenium
sulfur dioxide
sulfur trioxide
sulfur oxides
tetrachlorodibenzodioxin
tetrachlorodi benzofura n
total gaseous organic concentration
total hydrocarbons
thallium
total reduced sulfur compounds
zinc
cadmium sulfide
CH2O formaldehyde
CH3CHO acetaldehyde
CH3OH methanol
CHr methane
C2H4O ethylene oxide
CzHo ethane
C3H4O acrolein
CaH6O propionaldehyde
CsHe propane
C6H'OH phenol
Clz
ClO2 chlorine dioxide
CO carbon monoxideCo cobalt
CO, carbon dioxide
Cr chromiumCu copperEtO ethylene oxideEIOH ethyl alcohol (ethanol)
H2
Hzo
hydrogen
water
HzO, hydrogen peroxide
HzS hydrogen sulfide
H2SO4 sulfuric acid
HCI hydrogen chlorideHg mercuryIPA isopropyl alcoholMDI methylene diphyenyl diisocyanate
MeCl2 methylene chloride
MEK methyl ethyl ketoneMeOH methanolMn manganese
N2
NHs
Ni
NO
NO,
NO,
o2
nitrogen
ammonia
nickel
nitric oxide
nitrogen dioxide
nilrogen oxides
oxygen
P phosphorusPb leadPCDD polychlorinated dibenzo-p{ioxinsPCDF polychlorinated dibenzofurans
antimony
GP043AS-036892-PP-9 1 5 Page 26 of 43
Appendix A.2
Accreditation Information / Certifications
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Appendix *S"
Field Work Safety Plan
MM?.NT\g[H
SITE SAFETY PLAN BOOKLET
Project:
Customer:
Location:
Units:
Client Project Manager:
Revision Date: January 21,2022
GP043AS-036892-PP-9 1 5 Page 30 of 43
firr!lL)NtRt)sl Page 1 of2
Site Safety Plan and JHA Purpose and !nstructions
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 several safety 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 8. 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 all employees 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 lndex
c. Extended Hours Form
AQS.FRM-1.13R1
Page 31 of 43GP043AS-036892-PP-9 1 5
oA lYlqfT+glt Page2ot2
Site Safety Plan and JHA Purpose and lnstructions
The SSP is a living document. The Project Manager should continually update their SSPs as
new information and conditions change or if new hazards are presented.
Each completed SSP should be maintained with the Test Plan in the office for a period of 3
years. There will be an audit process developed for the Site Safety Plans.
AQS-FRM-1.13R1
Page 32 of 43GP043AS-036892-PP-9 1 5
PROJECT NAM E/LOCATION :
TEST DATE:
PROJECT #:
PROJECT MANAGER:
TEST SCOPE:
SITE CONTACT: Name:Contact Phone:
,a \ Mt)N I lit )sl
Page 1 of2
PRE.MOBILIZATION TEST INFORMATION
Source Tvpe: 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
CO
tr
NOx
tr
SOz
tr
VOC
tr
other
lf other, explain:
Flammable:Toxic: Corrosive: Dust:
Engineering Controls to be lmplemented:
Additional Safety Equipment Required:
Personal gas monitors: _
Respiratory Protection :
Half Face_ Full Face_ HEPA Filters
Approximate Flue Gas Temperatures, (F)
_ Supplied Air: (Safety Dept. Approval)
tr
below 210 210 to 450 450 to 950 above 950 other
lf other, explain:
Approximate Duct Pressure, (iwg):
tr
below
trtr
-3 -3 to +3 +3 to +7
tr
above
u
+7 other
lf other, explain:
AQS.FRM-1.17
GP043AS-036892-PP-9 1 5 Page 33 of 43
,a , M(-rN I ltt).rl
Sampling Location: Stack Port _
Approximate Sampling Platform Height, (ft)
PRE.MOBILIZATION TEST INFORMATION
Page 2 o'f 2
tr
6to50
tr
other
tr
50 to 100
Duct Port _
tr
above 100below 6
lf other, explain:
Access and Protection:
Elevators: _ Ladders: MEWP Lift: _ Scaffold: _ Equipment Hoist: _
Guardrails: _ Toe plate: _ Engineered Tie Off Points:
Other:
Heat Shield:
Describe how equipment will be mobilized to the sampling location:
Additional lnformation :
Effluent Chemical Requlatorv Limits
Gas Name Chemical
Formula
Cal OSHA PEL1
(ppm)
Cal OSHA
STEL2
lnoml
NIOSH REL
TWA3 (ppm)
Cal OSHA
Ceiling
looml
IDLH.
(ppm)
Carbon Monoxide co 25 200 35 200 1,200
Nitric Oxide NO"25 ND5 25 ND 100
Sulfur Dioxide SOz 2 5 2 ND 100
Hvdrooen Chloride HCI 0.3 2 ND 2 50
Hydrogen Sulfide HzS 10 15 10 (10 min.)c 50 100
jalifomia Occupational Safety and Health Administntion (OSHA) Permissible Exposure Limit (PEL) based on an ?-hour shift;
2: Cal OSHA Shotl-lerm Exposure Limit (STEL) based on a 1S-minute period;
3: National lnstitute for Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL) Time-weighted Average (TWA) based
on an B-hour shift:
4: lmmediately Dangerous to Life or Health (IDLH);
5: Not Defined (ND);
C: Ceiling Limit - Maximum allowable human exposure limit for an airbome or gaseous subsfance, which is not to be exceeded, even
momentarily.
Prepared by:
Reviewed by:
Date:
Date:
AQS-FRM.1.17
GP043AS-036892-PP-9 1 5 Page 34 of 43
llient Contact Name )ate
:acility SSP Writer fM
llient Rep I
Job Preparation
I lon Site walk Through Completed tr
I Safe Work Permit Received from Client
-]
Site Specific Training Complete
lf the heat index is expected to be above 91", fill out the Heat Stress Prevention Form.
\ r!l(rN I lr()\l Job Hazard Analysis 1of3/.v
1.
2.
3.RIsK
E Time Pressure E Remote Work Location E > 't2 hr shift [ Wo*ing > 8 consecufve days
E Lack of procedures E Extreme temps, wind >30mph E Personal illness/fatigue E Vague work guidance
E Monotonous Ac{ivity E First day back after time off E fuumpf jou locations E oher:
Physical Hazards
Dust Hazards
Thermal Bum
Electrical Hazards
lnadequate Lighting
Slip and Trip
Hand Protection
Potential Hazards for Consideration
Secondary Permits
Working from Heights
See a}lo tlec-t.7
Electrical
Lifting
Respiratory
See also Sect.8
Hazard Controls
E Dust Mask ! Goggles E Other:
E Hot Gloves fl neat Shields ElOttrer Protective Clothing:
E Connections Protected from Elements I External GFCI E Other:
E Xe nating Requirement E lntrinsically Safe Requirement
E lnstall Temporary Lighting E Headlamps
! Housekeeping E Barricade Area E Other:
E Cut Resistant Gloves E Pinch Pts. El General El gbctrcat E] lmpact Resistant
E ottrer:
El Hot Work E Confined Space ! Excavation
E ratting objects E Fall protection E Drop zone protection E] Phtform load ratings
f] ScafoE inspection E Ladder inspection E Banicades for equipment
I Exposed wire/connector E Verify equipment groundins E Arc Flash
! Crane lift plan E Rigging inspection E fag linee used E Hoists in place
E Unexpected exposure E Chemical E Dust (combustible) E] PEL provided
E Cartridqes or supplied air available E Gas detection equi
RequiredPPE EHardHats IsafetyGlasses EsafetytoeShoe/Boot f]HearingProtection ESafeVSpotter
E Hi-Vis Vests E Harness/Lanyard* fl Goggles E Personal Monitor Type:
E Metatarsal Guards E Hot Gloves E Face Shield E Respirator Type:
E Nomex/FRC E Other PPE:
AQS-FRM-1.18
Page 35 of 43
acility lnformation/Emergency Preparedness
lf non+mergency medical attention is needed, call: AXIOM #: 877-502'9466.
Plant Emergency #
EMS Location
Certified First Aid Person:
Evacuation Routes Rally Point
Severe Weather Shelter Location Eye Wash & Safety Shower Location
Operational: EYes INo
Source lnformation: (list type):
Stack Gas Temp. ('F) Stack Gas Press' ("H2O) Stack Gas Components:
Stack Gas lnhalation Potential? EYes E ruo lf ves. see List of Hazard Chemicals.
GP043AS-036892-PP-9 1 5
zlv r Nl()N I R())t
Additional Work Place Hazards
Job Hazard Analysis 2of3
Procedures - check all that apply - *indicates additional form must be completed or collected from client
E Heat Stress Prevention* E Confined Space* D MEWP. E Roof Work E Scaffold
E CotO Wealher Work I Hazardous Energy Control- f] Exposure Monitoring E Other:
From Heights
Fall Protection
Falling ObJects Protectlon
Fall Hazard Communication
E Fixed Guardrails/Toe boards E fatt Prevention PPE Warning Line System
E aantcaOing E Netting ! House Keeping f] Tethered Tools E Catctr Blanket or Tarp
E AdjacenVOverhead Workers I Contractor Contact E Client Contact
)ther Considerations
Environmental Hazards - Weather Forecast
E HeauCotd [lLightning E Rain E Snow f] tce El Tornado ! wind Speed
Steps for Mitigation:
ectrical Safety Plannlng
Plant Hook up: E t tov f zzotz+ov E +aov E Generator E Hard wired into panel
Electrical Classified Area: l-']Yes fl No Trailer Grounded: Ll Yes E tlo Plug Type
Electrical Hook Up Responsibility:
ist of Hazardous Chemicals
E Acetone E ttitric Acio
Other Chomicals:
E Hydrogen Peroxide fI Compressed Gases
E Hexane E Sufuric Acid E lsopropyl Alcohol I Flammable Gas
E Toluene fJ Hydrochloric Acid E liquio Nitrogen f] Non-Flammable Gas
E Hzs E Carbon Monoxide
Steps for Mitigation:
fildlife/Fauna in Area
I Poison lvy f] Poison oak Elnsects:flWildlife:
Personnel w/ known allergies to bees stings or other allergens? ! Yes Eruo
Hazards and Mitigation Steps
1
2
3
1
2
3
1
2
3
1
2
3
AOS-FRM.1.18
Page 36 of 43GP043AS-036892-PP-9 1 5
JHA REVIEW: Crew Names & Slgnatures
Printed Name Siqnature Date Printed Name Siqnature Date
&-. ML)N i RL))t Job Hazard Analysis 3of3
11
AQS-FRM-1.18
Page 37 of 43
JHA Meetinq & Review
to review:
. Change in conditions o Extended work hours o Daily Safety Topic
r New workers or contractors o Occurrence of near misses or injuries
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.
Dey Dlccurglon Toplc lnltelr
2
3
4
5
6
7
8
9
10
11
GP043AS-036892-PP-9 1 5
,.v \ rvl \ )r\ t lr\ }\l
Page 7 of 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
procedures, assembly/ rally points, alert systems, and signals prior to work commencing. In 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.
.You must follow the client's emergency action plan first, and notify your Supervisor immediately.
.lf incident is life threatening, CALL 911 IMMEDIATELLY
.lf non-emergency medical attention is needed, call AXIOM Medical number: 877-502-9466.
AQS.FRM-1.11
GP043AS-036892-PP-9 1 5
1 MEG Job Supervisor/ CPM's Name:
2 MEG Job Supervisor/ CPM's Telephone Number:
3 MEG Job Safety Supervisor (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 Channel:
I Plant's #1 Contact Person's Name:
I Plant's #1 Contact Person's Telephone Number:
10 Plant's #2 Contact Person's Name:
11 Plant's #2 Gontact 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 Ihe First Aid Kit is Located:
17 fhe Fire Extinguisher is Located:
Page 3B of 43
1 Facility Name:
2 Facility Alarm (Circle):YES or NO
3
Alarm Tones:
4 Designated Shelter(s) Description:
5 Designated Assembly Point(s) Description:
N*+'
s
Draw the evacuation and assembly map here
EMERGENCY ACTION PLAN FORM AND EVACUATION ASSEMBTY MAP REVIEW: Crew Names and Signatures
Printed Name:Signature:Date:Printed Name:Signature:Date:
/a\Mt)Nll{t)5t Poqe 2 of 2
EMERGENCY EVACUATION AND ASSEMBLY MAP
AQS-FRM-1.11
GP043AS-036892-PP-9 1 5 Page 39 of 43
fvr/vtLri\lK\)\t 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."
Iteme to be lnspected
1. All MEWP liff 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. wom 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 wlnds are 20 mph, unless othenrlse specified by manufacturer
recommendations.
Yes
u
D
!
D
tr
tr
tr
!
tr
D
tr
u
n
u
n
N/A
u
tr
tr
No
n
n
!
D!
Dtr
DD
!tr
trtr
utr
trtr
trtr
tru
DD
!!
nn
Operator Name & Signature Location Date
Ground Control Name & Signature Location Date
Harness lnspections:
Printed Name Signature Date
Printed Name Signature Date
Printed Name
GP043AS-036892-PP-9 1 5
Date
AQS-FRM-1.16
Page 40 of 43
Signature
The test leader should look for signs of the following in their crews:
o lrritability. Lack of motivation. Headaches. Giddiness
o Fatigue. Depression. Reduced alertness, lack of concentration and
memory
The test leader should assess the environmental and hazardous concerns:
6n MONTROSE Page I 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 RegionalVice
President (RVP). Technical RVPs can authorize moving foruard, if they are in the field or if they are
managing the project.
1. Hold test crew meetinq Test crew initials:
o Temperature and weather o Hoistingo 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
a
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.SAFETY-FM-3
Page 41 of 43GP043AS-036892-PP-9 1 5
er'\ MUN I RUst-
Page 1 of 1
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 Manaqer (PM):Expected Hiqh Temp:
Date(s):Exoected Heat lndex:
1.
2.
Review the signs of Heat Exhaustion and Heat Stroke
lf Heat lndex is above 91' F:. Provide cold water and/or sports drinks to all field 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
timeo PM should interview each field staff every 2 hours to evaluate for signs of heat illness
3.
OOlAS-SAFETY-FM.5
Page 42 of 43
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GP043AS-036892-PP-9 1 5
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 : CKormylo@ montrose-env. com
Phone: [phone]
Name: Glen Capra
Title: Vice President
Region: USA - Stack
Email : [e-mail]
Phone: (5L2) 772-6450
UTAH DFPARTMEI'JT OF
ENVIRONMENTAL QUALITYr-I
II sFP ?42024ll
DIVISION OF AIR OTJALITY
GP043AS,036892-PP-9 1 5 Page 43 of 43