DAQ-2024-006981

1

DAQC-251-24
Site ID 10096 (B5)
MEMORANDUM

TO: CEM FILE – SUNNYSIDE COGENERATION ASSOCIATES

THROUGH: Harold Burge, Major Source Compliance Section Manager

FROM: Rob Leishman, Environmental Scientist

DATE: March 22, 2024

SUBJECT: Source: Unit 1 – Fluidized Bed Combustion Boiler
Contact: Rusty Netz – 435-888-4476 ext. 107
Location: 1 Power Plant Road, Sunnyside, Carbon County, UT 84539
Test Contractor: Montrose Air Quality Services
FRS ID#: UT00000049000700030
Permit/AO#: Title V operating permit 700030005 dated March 8, 2023
Subject: Review of RA/PST Protocol dated February 16, 2024

On February 28, 2024, DAQ received a protocol for a RA/PST (relative accuracy/performance
specification test) of the Sunnyside Unit 1 in East Carbon, UT. Testing will be performed on May 21,
2024, to determine the relative accuracy of the O2, CO2, NOX, SO2, and CO monitoring systems.

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 3A used to determine dry molecular weight of the gas stream: OK
4. RM 4 used to determine moisture content: OK
5. RM 6C used to determine SO2 emissions: OK
6. RM 7E used to determine NOX concentrations of emissions: OK
7. RM 10 used to determine CO concentrations of emissions: OK
8. RM 19 used to determine volumetric flow: OK
DEVIATIONS: No deviations were noted.

CONCLUSION: The protocol appears to be acceptable.

RECOMMENDATION: Send attached protocol review and test date confirmation notice.

1 8 2
Sun nyside Cogeneration Associates
P.O. Box 159 . Sunnyside,Utah 84-539 . [phone]' Fax[phone]
February 16,2024
Rob Leishman
Division of Air Quality
195 North 1950 West
Salt Lake City, Utah 84l16
Re: RATA and CO Test Protocol
Title V Permit Number # 700030005
I'TAH DEPAHTMENT OF
ETWIRONMENTAL OUAIITY
FEB 2 B 2A24
DIVISION OF AIB QUALIT\'
flear Mr. Leishman:
Included is the Test Protocol for the 2024 rclative accuracy test audit (RATA) and
CO compliance testing at SCA, which is scheduled for May 27,2024.
Montrose Air Quality Services will be performing the tests again this year. Thc
tests to be conducted are the relative accuracy test audits for sulfur dioxide (SO2),
nitnogen oxide (NOx), oxygen (O2), Carbon Dioxide (CO2) and volumetric flow. AIso,
being tested is carbon monoxide (CO) compliance.
If you have any questions or concems regarding the test protocol, please feel free
to call Rusty Netz or myself at (435) 8884476.
**ru*'AUW
Edward McCourt
Agent for
Sunnyside Cogeneration Associates
Rusty Netz
Plant File
Source Test Plan
2fJ24 Relative Accuracy Test Audits and
Compliance Testing
Unit EU#1
Sun nyside 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-O25822-PP-810
Proposed Test Date: Vlay 2L, 2(J24
Submittal Date: April 21,2024
UTAH DEPARTMENT OF
ENVIRONMENTAL OUAL]TY
DIVISION OF AIH QUALITy
a D . n,_1,
sA@ffi
,* a9r* Dt$. *al
I have reviewed, technically and editorialli, details and other appropriate written materials
contained herein. I hereby certify that to tfe best of my knowledge the presented material
is authentic and accurate and conforms to lthe requirements of the Montrose Quality
Management System and ASTM D7O36-O4,
Review and Ceftification
I certify that, to the best of my knowledgq the information contained in this document is
complete and accurate and conforms to thb requirements of the Montrose Quality
2/L5/2O24
Matthew Parks I ritt", eA/ec Anatyst
2/tsl2024
Name:Tim Wojtach Title:Account Manager
GP043AS-025822-PP-8 10 Page 2 of 47
Table of Contents
Section Pase
1.0 Introduction . ............ 5
1.1 Summary of Test Program .............5
1.2 Applicable Regulations and Emission Limits .........6
1.3 Key Personnel..... ........... B
2.0 Plant and Sampling Location Descriptions........ ...........9
2.1 Process Description, Operation, and Control Equipment..... ............9
2.2 CEMS Description .......9
2.3 Flue Gas Sampling Locations .........10
2.4 Operating Conditions and Process Data. .............10
2.5 Plant Safety...... .............10
2.5.1 Safety Responsibilities...... ...............11
2.5.2 Safety Program and Requirements :......... ............12
3.0 Sampling and Analytical Procedures .........13
3.1 Test Methods..... ............13
3.1.1 EPA Method 2...... .........13
3.1.2 EPA Method 4...... ..........15
3.1.3 EPA Methods 3A, 6C, 7E, and 10 ...... ,......16
3.2 Process Test Methods...... .......18
4.0 Quality Assurance and Repofting...... .....18
4.L QA Audits.. ..........18
4.2 Quality Control Procedures ..........18
4.2.L Equipment Inspection and Maintenance ........ .......18
4.2.2 AuditSamples ..........18
4.3 Data Analysis and Validation ..........19
4.4 Sample Identification and Custody ............19
4.5 Quality Statement .......19
4.6 Repofting .. ... 19
4.6.1 Example Report Format ..........2O
4.6.2 Example Presentation of Test Results........ .......2L
List of Appendices
Appendix A Supporting Information ...... .......22
Appendix A.1 Units and Abbreviations ............23
Appendix A.2 Accreditation Information/Certifications.... .......31
Appendix "S" Field Work Safety Plan ...........33
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GP043AS-025822-PP-B 10
List of Tables
Table 1-1
Table 1-2
Table 1-3
Table 1-4
Table 1-5
Table 2-1
Table2-2
Table 4-1
Summary of Test Program and
Reporting Units and Applicable
Summary of Paft 60175 RA Re
Summary of Emission Limits....
Test Personnel and Responsibili
CEMS Information
Sampling Locations
Example NOx (lblmmBtu) RAT,
B
9
9
10
L4
15
20
roposed Schedule... ...... 5
List of Figures
Figure 3-1 EPA Method 2 SamplingTrain.
Figure 3-2 EPA Method 4 Sampling Train.
Figure 3-3 EPA Methods 34, 6C, 7E, and
Figure 4-1 Typical Report Format
GP043AS-025822-PP-8 10 Page 4 of 47
1.O Introduction
1.1 Summary of Test Program
Sunnyside Cogeneration Associates contracted Montrose Air Quality Services, LLC
(Montrose) to perform a testing program at Sunnyside Power Plant located near Sunnyside,
Utah. Testing will be conducted in accordance with the testing requirements of Utah
Depaftment of Environmental Quality (UDEQ) Operating Permit 700030002 and (as
applicable) 40 CFR Parts 60 and 75.
The specific objectives are to:
. Perform annual Relative Accuracy Test Audits (RATAs) on the Continuous
Emission Monitoring Systems (CEMS) installed on Unit EU#1
. Pefform annual carbon monoxide (CO) compliance testing on the exhaust
stack of Unit EU#1
. 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
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Volumetric Flow Rate RATA : EPA 1, 2,3,4 9-72
COz, SOz, NO,, CO RATAs EPA 34, 6C,7E, LO 9-L2
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21 minst2ltzoz4 Jrlt, . IiSl
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.
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GP043AS-025822-PP-8 10 Page 5 of 47
L.2 Applicable Regulation and Emission Limits
The results from this test program are
applicable regulations or requirements.
presented in Table 1-2.
in units consistent with those listed in the
reporting units and emission limits are
Table 1-2
Reporting Units and Applicable
Unit EU#1 Volumetric Flow Rate
,
I
Unit EU#1 I COz
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t
,
Unit EU#l ' SOu, NO*, CO
wscftr
o/ovw
ppmvw, lb/mmBtu, lblhr
GP043AS-025822-PP-810 Page 6 of 47
The M requirements are presented in Table 1-3.
Table 1-3
Summary of Part 60175 RA Requirements
Part 6O
: ppmvd
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i tblhr
i Part75
j oxygen (oz)
' o/o volume dry
dscfh App. B Sect. 2.3.1.2
d v______*___*_ Lll*i_ls"9lj:"1_l
Volumetric Flow
Annual: < 7.5o/o of RM or + 1.5 fps(l)
(1) Alternate is for low flow (RM measurements are < 10.0 fps)
(2) Alternate is for low emitter (average SOz or NOx RM concentrations are S 250 ppm, or average NOx RM emissbn
rates are s 0.200 lb/MMBtu)
GP043AS-025822-PP-8 10 PageT of 47
The applicable permit limits are presented lin Table 1-4.
Table 1-4
Summaly of Emission Limits
i c3 P! l-I_" 1o;ia _e_ (c-!_)
lblmmBtu 700030002
1.3 Key Personnel
A list of project pafticipants is included
Facility Information
Source Location: Sunnyside
Project Contact:
Role:
Company:
Telephone:
Email:
Agency Information
Regulatory Agency:
Agenry Contact:
Telephone:
Email:
Sunnyside Power
1 Power Plant
Sunnyside, UT 845
Rusty Netz
Environmental Ad
Sunnyside
[phone] x
rusnetz@hotmall
Utah Department
Rob Leishman
[phone]
RLeishman@utah.
tion Associates
nt
Associates
Air Quality
Services, LLC
Testing Company Information
Testing Firm: Montrose Air Quali
Contact: Craig Kormylo
Title: DistrictManager
Telephone: [phone]
Email: CKormylo@
GP043AS-025822-PP-B 10 Page I of 47
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Table 1-5 details the roles and responsibilities of the test team.
Table 1-5
Test Personnel and Responsibilities
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Field Project Manager
' Technician
Operate mobile lab
Execute stack platform
responsibilities
Facility interface, test
;rew
coordination
Preparation, support PM
2.O Plant and Sampling Location Descriptions
Equipment
2.L Process Description, Operation, and Control
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 #1, an emergency backup diesel-fired Fump, diesel storage
tanks, coal handling equipment, ash handling equipment and limestone handling equipment.
EU #1 has a rating of 700 mmBtu/hr and is equipped 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 CEMS Description
The CEMS analyzers are presented in Table 2-1.
Table 2-1
CEMS Information
i.l,',' '
ilonitor Location Parameter }lonitor lrlake / Irlodel Serial l{umber
,Flow _ :DuragDR2gO -4_L.7243
, SOz EcoChem MC3 425
NO' EcoChem MC3 425
GP043AS-025822-PP-B 10 Page 9 of 47
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2.3 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 2-2 presents the anticipated
stack measurements and traverse points for the sampling locations listed.
Table 2-2
Sampling Locations
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Unit EU#1
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Upstream EPA
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Flow: 16 Glport)
Gas; 12 (3/port)
Sample location(s) are verified in the field to conform to EPA Method 1. Acceptable cyclonic
flow conditions are confirmed prior to testing using EPA Method 1, Section 11.4.
2.4 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 at greater than 50o/o of rated capacity, as required by 40 CFR Part 60 or within
the load levels required by 40 CFR Part 75.
Plant personnel are responsible for establishing the test conditions and collecting all
applicable unit-operating data. Data collected includes the following parameters:
. Unit load (MW)
. Relevant CEMS Parameters
2.5 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.
GP043AS-025822-PP-B 10 Page LO of 47
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2.5.1 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
. 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.
. 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 Subpaft A, Section 60.8, the facility must provide the
following provisions at each sample location:
: Sampling ports, which meet EPA minimum requirements for testing. The
caps should be removed or be hand-tight.
. Safe sampling platforms
. Safe access to the platforms and test ports, including any scaffolding or
man lifts
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
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GP043AS-025822-PP-B 10 Page LL of 47
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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.
2.5.2 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 and
FMCSA
. 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-025822-PP-B 10 Page 12 of 47
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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 2, Determination of Gas Velocity and Volumetric
Flow Rate (Type S Pitot Tube)
EPA Method 2 is used to measure the gas velocity using an S-type pitot tube connected to a
pressure measurement device, and to measure the gas temperature using a calibrated
thermocouple connected to a thermocouple indicator. Typically, Type S (Stausscheibe) pitot
tubes conforming to the geometric speciflcations in the test method are used, along with an
inclined manometer. The measurements are made at traverse points specified by EPA
Method 1. The molecular weight of the gas stream is determined from independent
measurements of Oz, COz, and moisture. The stack gas volumetric flow rate is calculated
using the measured average velocity head, the area of the duct at the measurement plane,
the measured average temperature, the measured duct static pressure, the molecular
weight of the gas stream, and the measured moisture.
Pertinent information regarding the performance of the method is presented below:
o Method Options:
.: S-type pitot tube coefficient is 0.84
. Method Exceptions:
c None
The typical sampling system is detailed in Figure 3-1.
GP043AS-025822-PP-B 10 Page 13 of 47
T
US EPA METHOD 2 SAMPLING TRAIN
FIGURE 3-1
GPO43AS-025822-PP-81 0 Page !4 of 47
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3.1.2 EPA Method 4
Determination of Moisture Content in Stack Gas
EPA Method 4 is a manual, non-isokinetic method used to measure the moisture content of
gas streams. Gas is sampled at a constant sampling rate through a probe and impinger
train. Moisture is removed using a series of pre-weighed impingers containing methodology-
specific liquids and silica gel immersed in an ice water bath. The impingers are weighed
after each run to determine the percent moisture.
The typical sampling system is detailed in Figure 3-2.
Figure 3-2
EPA Method 4 Sampling Train
VACUUM+ LINE
ADAPTOR
trI
(tP) 2oo
Silca Gel
(modtieilnotb)
(sladad tip)
BY.PASS VALVE(tiredtud) VACUUM GAUGE
Page 15 of 47
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3.1.3 EPA Methods 3A, 6C, 7E, and 1O
Determination of Oxygen, Carbon Dioxide, Sulfur Dioxide, Nitrogen Oxides,
and Carbon Monoxide Concentrations in Emissions from Stationary Sources
(Instrumental Analyzer Procedures)
Concentrations of Oz, COz, SOz, NOx, and CO are measured simultaneously using EPA
Methods 3A, 6C, 7E, and 10, which are instrumental test methods. Conditioned gas is sent
to a series of analyzers to measure the gaseous emission concentrations. The performance
requirements of the method must be met to validate the data.
Pertinent information regarding the performance of the method is presented below:
. Method Options:
, NO and NOz are measured separately and summed to report NOx
emissions
r., The alternative NOx converter efficiency test described in EPA Method 7E
Section 16.2 may be used (bag procedure)
:; Gas stratification testing is performed across a grid of 12 points
determined using EPA Method 1 in accordance with 40 CFR Part 60,
Aooendix B. PS2 68.1.3.2 and 40 CFR Paft 75. Appendix A. 66.5.6.1.
Stratification testing is performed for two minutes per traverse point in
accordance with 40 CFR Part 75. Appendix A. 66.5.6.1(c). If diluent and
pollutant concentrations are within 5o/o of their mean concentrations,
subsequent gas RATA testing is performed at a single point in the stack as
allowed by 40 CFR Part 60. Appendix B, PS2 68.1.3.2 and 40 CFR Part 75,
Appendix A 86.5.6.3(b). If diluent and pollutant concentrations are within
10o/o of their mean concentrations, RATA testing is performed at three
points located 0.4 meter, 1.0 meter and 2.0 meters from the stack wall,
as required by 40 CFR Part 60. Apoendix B. PS2 68.1.3.2 and 40 CFR Part
75. Aooendix A. 66.5.6.1(a).
The typical sampling system is detailed in Figure 3-3.
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GP043AS-025822-PP-810 Page 76 of 47
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EPA Methods 3A, 6C,7E, and 10 Sampling Train
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HEATED
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LIN E
SIGNAL Exha ud
Sarple / C alihration Gas
Exhaud
BSROTAETER
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3.2 Process Test Methods
The applicable regulations do not require process samples to be collected during this test
program.
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 pefform 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 peformed 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.t 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.
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GP043AS-025822-PP-B 10
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" for this project are 29.92
inches of mercury and 68 oF.
4.4 Sample ldentification and Custody
No samples are required to be recovered for this test program.
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 7.2.1and t2.LO. 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 repoft 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
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.
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GP043AS-025822-PP-B 10 Page 19 of 47
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I :i:i.::a::;ir::::::::
tr:]i-j-=.,,
ffiiii
4.6.L Example Report Format
The repoft is divided into various sections describing the different aspects of the source
testing program. Figure 4-1 presents a typical Table of Contents forthe final report.
Figure 4-1
Typical Repod Format Cover Page
Cedification of Repoft
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 CEMS and Process Data
C Laboratory Analysis Data
D Quality Assurance/Quality Control
E Regulatory Information
GP043AS-025822-PP-B 10
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 repoft. Separate tables will outline the results for each CEMS parameter/set
of units and compare them to their respective RA requirements.
Table 4-1
Example NOx (lblmmBtu) RATA Results - Unit Name
xx/xx/xxxx xxxx-xxxx
i10 :xx/xx/xxxx_i.xxxl(:Ixxx-,--Il *j ."*xI *. XT"_** ..*I ^_;. II* "-i ****'* *r ' *l '"* * - "* i :- '*--11 , xx/xx/xxxx i xxxx-xxxx , xx i xx i xx x xx :: r "" "-i T;i-i*-xx x -ix
Ii 12 i "IyIYIYLL-xx)s:xxxI- r:* : , - --*'- ,*--,.-- *
i
i
1
"" ':_l
-t
1*-*,-1
1"":'--*.j
t
.....-.-.-.-*t
1
I.t
1
t**-a
.*,
GP043AS-025822-PP-8 10 Page 21 of 47
Ap
Supporti
ndix A
Information
Appendix A.1
Units and Abbreviations
6C l*g,s,rsg[,E
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
pS microgram
Pa density of acetone, mg/ml
Pw density of water, 0.9982 g/ml or 0.002201 lb/ml
acfrn actual cubic feet of gas per minute at stack conditions
An cross-sectional area of nozzle,ft'
As cross-sectional area of stack, square feet (#)
Btu British thermal unit
B*. proportion by volume of water vapor in gas stream
Ca particulate matter concentration in stack gas, grlacf
Cnrg average unadjusted gas concentration, ppmv
Coi, measured concentration of calibration gas, ppmv
cf or ft3 cubic feetcfm cubic feet per minute
Cc"" 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
Crtra actual concentration of the upscale calibration gas, ppmv
Co average of initial and final system bias check responses from low]evel calibration gas, ppmv
Cp pitot tube coefficient
C" 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 cubicfeet
dcm dry cubic meters
Dn diameter of nozzle, inches
Ds diameter of stack, inches
dscf dry standard cubic feet
dscfrn dry standard cubic feet per minute
dscm dry standard cubic meters
Fd F-factor, dscf/MMBtu of heat input
fpm feet per minute
fps feet per second
ft feet( square feet
9 gram
gal gallons
gr grains (7000 grains per pound)
grldscf grains per dry standard cubic feet
hourhr
cP043AS-025822-PP-8 10 Page 24 ot 47
60 **.o*N,I+g[,H
UNITS AND ABBREVIATIONS
I percent of isokinetic samplingin inch
k kilo or thousand (metric units, multiply by 103)K kelvin (temperature)
K3 conversion factor 0.0154 gr/mg
K4 conversion factor 0.002668 ((in. HgXft'))/((mlX'R))
kg kilogram
q pitot tube constant (85.49 fUsec)
kwscfh thousand wet standard cubic feet per hour
I liters
lb/hr pounds per hour
lb/MMBtu pounds per million Btu
lpm liters per minutem meter or milliM 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 millimeterMM million (English units)MMBtu/hr million Btu per hour
mn total amount of particulate matter collected, mg
mol mole
mol. wt. 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 prcogram
Ps stack static pressure, inches HrO
P. 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, scfm
Qsta volumetric flow rate, dry standard conditions, dscfm
R idealgas constant 21.85 ((in. Hg) (ft3)y(('R) (lbmole))
GP043AS-025822-PP-B 10 Page 25 of 47
60 l*?,x,T+R[,H
UNITS AND ABBREVIATIONS
SBrna post-run system bias check, o/o of span
SBi pre-run system bias check, % ofspan
scf standard cubic feet
scfrr 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 ft2 square feet
std standard
t metric ton (1000 kg)
T o.szs t-value
T" absolute average ambient temperature, oR (+459.67 for English)
Tm 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)
T.ro absolute temperature at standard onditions
V
%
Vil
V"
v.
Vm(std)
vm
%
%
Vwqsto)
V*i("ra)
Vmgl{d1
W
w"
Wi.p
Wss
volt
volume of acetone blank, ml
volume of acetone used in wash, ml
total volume H2O collected in impirqers and silica gel, grams
volume of gas sampled through dry gas meter, ftJ
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 nozAe, acf
average stack gas velocity, feet per second
volume of water vapor condensed, conected to standard conditions, scf
volume of water vapor in gas samfled from impingers, scf
volume of water vapor in gas sam$ed 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-025822-PP-8 10 Page 26 of 47
60 l1?,NT+g[,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
atom ic 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 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
fl ame ionization detector
fl ame photometric detector
fi lterable particulate matter
Fourier-transform i nfrared spectroscopy
field train proof blank
field train recovery blank
polychlorinated dibenzofurans (pcdf s)
gas chromatography
GP043AS-025822-PP-B 10 Page 27 of 47
c4\ **?,N,T*P"[A
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 available
NCASI National Council For Air And Steam lmprovement
NCG non-condensable gases
ND not detected
NDIR non-dispersive infrared
NESHAP 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 cutter
NMOC non-methane organic compounds
NMVOC non-methane volatile organic compounds
NPD 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 distribution
PSEL plant site emission limits
PST performance specification test
PTE permanent total enclosure
PTM performance test method
GP043AS-025822-PP-8 10 Page 28 of 47
6c ll?.#,I+gffi
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 methodRTO regenerative thermal oxidizerSAM sulfuric acid mist
SCD sulfur chemiluminescent detectorSCR 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 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 oxidizerTO toxic organic (as in EPA Method TO-15)TPM total particulate matterTSP total suspended particulate matterTTE temporary total enclosureULSD ultra]ow sulfur dieselUV ultraviolet radiation rangeVE visible emissions
VOC volatile organic compoundsVOST volatile organic sample trainWC water column
! /WTP waste water treatment plant
GP043AS-025822-PP-B 10 Page 29 of 47
66 S?,N,Iqgp.A
AS silver
As arsenic
Ba barium
Be beryllium
C carbon
Cd cadmium
CdS cadmium sulfide
CH2O formaldehyde
CH3CHO acetaldehyde
CH3OH methanol
CHo methane
C2H4O ethylene oxide
CzHu ethane
CaH4O acrolein
CaH6O propionaldehyde
C.Hu propane
C6H5OH phenol
Cl, chlorine
ClO2 chlorine dioxide
CO carbon monoxide
Co cobalt
CO, carbon dioxide
Cr chromium
Cu copper
EtO ethylene oxide
EtOH ethyl alcohol (ethanol)
H2 hydrogen
HrO water
HzO, hydrogen peroxide
HrS hydrogen sulfide
H2SO4 sulfuric acid
HCI hydrogen chloride
Hg mercury
IPA isopropyl alcohol
MDI methylene diphyenyl diisocyanate
MeCl2 methylene chloride
MEK methyl ethyl ketone
MeOH methanol
Mn manganese
N2 nitrogen
NH: ammonia
Ni nickel
NO nitric oxide
NOz nitrogen dioxide
NO, nitrogen oxides
02 orygen
P phosphorus
Pb lead
PCDD polychlorinated dibenzo-p-dioxins
PCDF polychlorinateddibenzofurans
Sb antimony
GHEMICAL NOMENCLATURE
Se selenium
SO, sulfur dioxide
SOe sulfur trioxide
SO, sulfur oxides
TCDD tetrachlorodibenzodioxinTCDF tetrachlorodibenzofuran
TGOC total gaseous organic concentration
THC total hydrocarbons
Tl thallium
TRS total reduced sulfur compounds
Zn zinc
GP043AS-025822-PP-B 10 Page 30 of47
Appendix A.2
Accred itation Information /Certifications
i:?a44"laa
lr::
,;'.
w
s
$
Accredited Air Emission, Testing Body
A2LA hos occredited
MONTROSE AIR QUALITY SERVICES
ln recognilion of lhe successful completion of the joinl A2LA ond Siock Tesiing Accreditoiion Council (STAC)
evoluotion process, this loboroiory is occredited to perform tesiing octivities in complionce with
ASTM D7036:2004 - Stondord Proctice for Competence of Air Emission Testing Bodies.
Vice Presidenl, Accreditoiion Services
For the Accreditotion Council
Certificote Number 3925.01
Volid to Februory 29,2024
GP043AS-025822-PP-8 10
PresenteQ ihis 4th doy ol Februory 2022.
laEe 32 ot 47
Appendix r\S"
Field Work Safety Plan
r*lu, Bru*,
WWM@ A WrWY; I
BFY1W \
I
&et}ru:m=ffiruffi
nIil {}fi}"eE"}TY \*-Ee\/r( H\i!r r. \qj./rs*
SITE SAFETIY PLAN BOOKLET
Project:
Customer:
Location:
Units:
Client Project
Revision Date: January 21,2022
GP043AS-025822-PP-810 Page 34 of 47
ffi,
Page 1 of2
Site Safety Plan and JHA Purpose and Instructions
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.
Instructions
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
tasl</site'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. tn 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 35 of 47GP043AS-025822-PP-810
Page2ot2
AQS-FRM-1.13R1
Page 36 of47
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.
L
,1.,o
J,N'
if
[rew
a llvitn
>l$Red
{#.'5 ffi1tP,'I"4'H}.fi
Site Safety Plan and J
The SSP is a living document. The Projeet I
new information and conditions change or il
Each completed SSP should be maintained
years. There will be an audit process devel
GP043AS-025822-PP-81 0
, \! 1 1-. t \ i
ffi'
Page 1 of 2
PRE.MOBILIZATION TEST INFORMATION
SgglggJype! New Source: _ Revisit: _ Prj#lDate/Tech:
Coal Fired Electric Utility: _ Ethanol Plant: _ Chemical Mfg. of
CemenVlime Kiln Plant: _ Specialty Mfg. of:Other:
Anticipated Effluent Composition - check all that apply and fill in expected concentration in ppmlYo
tr
NOx
lf other, explain:
Flammable:Toxic: Corrosive: Dust:
Engineering Controls to be lmplemented:
tr
co
tr
other
tr
VOC
tr
SOz
PROJECT NAM E/LOCATION :
TEST DATE:
PROJECT #:
PROJECT MANAGER:
TEST SCOPE:
SITE CONTACT: Name:Contact Phone:
Additional Safety Equipment Required:
Personal gas monitors: _
Respiratory Protection :
Half Face_ Full Face_ HEPA Filters_ Supplied Air: _ (Safety Dept. Approval)
Approximate Flue Gas Temperatures, (F)
below 2'10 210 to 450 450 to 950 above 950 other
lf other, explain:
Approximate Duct Pressure, (iwg):
tr
above
lf other,
n
tr
below
explain: _
trtr
-3 -3 to +3 +3 to +7
tr
+7 other
AQS-FRM-1.17
GP043AS-025822-PP-810 Page 37 of 47
tr
below 6
lf other, explain:
trtr
6 to 50 50 to 100
tr
100 other
6',, iv'ti"JJ\ i iq$"i.}ll
Page 2 of 2
PRE.MOBILIZATION TEST INFORMATION
Sampling Location: Stack Port _ Duct Port _
Approximate Sampling Platform Height, (ft)
tr
above
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:
Additional lnformation:
Effluent Chemical Requlatorv Limits
Gas Name Ghemical
Formula
Cal OSHA FELI
(ppm)
Cal OSHA
STEL2
(onml
NIOSH REL
TWA3 (ppm)
Cal OSHA
Geiling
Innml
IDLHl
(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
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 Administration (OSHA) Pemissible Exposure Limit (PEL) based on an 8-hour shift;
2: Cal OSHA Short-term Exposure Linit (STEL) based on a 15-minute peiod;
3: National lnstitute for Occupational Safety and Heafth (NIOSH) Recommended Exposure Limit (REL) Time-weighted Average (TWA) based
on an 8-hour shift;
4: lmmediately Dangerous to Life or Heafth (IDLH);
5: Not Defined (ND);
C: Ceiling Limit - Maximum allowable human exposure limit for an airbome or gaseous substarrce, which is not to be exceeded, even
momentaily.
Prepared by:
Reviewed by:
Date:
Date:
AQS-FRM-1.17
GP043AS-025822-PP-810 Page 38 of 47
3lient Contact Name Date
Facility SSP Writer PM
llient Rep I
Job Preparation
[ .too Site walk Through Completed tr
f] Sate Work Permit Received from Client
I
Site Specific Training Complete
lf the heat index is expected to be above 91', fill out the Heat Stress Prevention Form.
Job Hazard Analysis 1of3
c:r:4
1.
2.
3.
4.
Risk
fl fime Pressure E Remote Work Location f] > 12 hr shift fl wo*ing > 8 consecutive days
E u"f of procedures E Exrerne temps, wind >3omph E Personal illnesslfatigue EJ Vague work guidance
E Monotonous Ac*ivity El f irst day back after time off E t tuttipp joo locations fl Other:
acility lnformation/Emergency Preparedness
lf non-emergency medical attention is needed, call: AXIOM #: 877-502-9466
Plant Emergency # Certified First Aid Person:
EMS Location Evacuation Routes Rally Point
Severe Weather Shelter Location Eye Wash & Safety Shower Location
Operational: EJYes INo
lnformation: (list type):
Stack Gas Temp. (oF) Stack Gas Press. ("HrO) Stack Gas Components:
Stack Gas lnhalation Potential? EYes E t'to tf ves. see List of Hazard Chemicats.
Hazards
Dust Hazards
Thermal Burn
Electrical Hazards
lnadequate Lighting
Slip and Trip
Hand Proteciion
Secondary Permits
Working from Heights
See also Sect 7
Electrical
Lifting
Respiratory
See also Sect. 8
Hazards for Consideration
Hazard Controls
I Dust Mask ! Goggles E Other:
[] HotGloves EHeatShields " EOtherProtediveClothing:
E Connections Protected from Elements ! External GFCI E Other:
E Xe nating Requirement E lntrinsically Safe Requirement
E lnstall Temporary Lighting I Headlamps
! Housekeeping E Barricade Area E Other:
E Cut Resistant Gloves E pincn pts. E O"n"t
E other:
E Hot Work E Confined Space E Excavation
f] fatting objeas D Fall protection E Drop zone protection I ehtform load ratings
I ScatfotO inspection E Ladder inspecfion f] Barricades for equipment
! Exposed wire/connector E Verify equipment groundinS E Arc Flash
fl Crane lift plan I Rigging inspection E fag lines used f] Hoists in place
E Unexpected exposure E Chemical E Dust (combustible) f] PEL provided
E Cartridqes or supplied air available L] Gas detection equipment
5.RequiredPPE EHardHats !safetyGlasses lsafetyToeShoe/Boot IHearingProtection flsafetySpotter
E Hi-Vis Vests E Harness/Lanyard* E Goggles ! 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 39 of 47GP043AS-025822-PP-B 10
.; , , .
Additional Work Place Hazards
Job Hazard Analysis 2of3
Critical Procedures - check all that apply - *indicates additional form must be completed or collected from client
E Heat Stress Prevention" E Confined Space" El MEWP- E Roof Work E Scattotd
ECotOWeatherWork IHazardousEnergyControf EExposureMonitoring EOther:
Working From Heights
Fall protection jI f*eO Guardrails/Toe boards E fatt Prevention PPE Warning Line System
Falling Objects protection i E aarricaOing tr Netting E House Keeping fl Tethered Tools Elcatctr Blanket or Tarp
Fall Hazard Communicatio. i trl AdjacenUOverhead Workers E Contractor Contact El Client Contact
:
8.
AQS-FRM-1.18
Page 40 of 47
Other Considerations
Environmental Hazards - Weather Forecast
E HeaUCold ELigntning I Rain E Snow E lce ! Tornado f] Wind Speed
Steps for Mitigation:
Electrical Safety Planning
PlantHookup: Ettov rl22ot24ov E aaov E cenerator EHardwiredintopanel
Electrical Classified Area: llYes E No Trailer Grounded: E yes ! tlo Plug Type
Electrical Hook Up Responsibility:
List of Hazardous Chemicals
El Acetone ! ruitric ncio I Hydrogen Peroxide E compressed Gases
E Hexane flSufuric Acid tr] lsopropyl Alcohol I Fhmmable Gas
E Toluene E Hydrochloric Acid fJ Liquio Nitrogen f] Non-Flammable Gas
E Hzs E carbon Monoxide
Steps for Mitigation:
Wldlife/Fauna in Area
I Poison lvy ! Poison oak Elnsects:IWildlife:
Personnel w/ known allergies to bees stings or other allergensZ ! Yes E r.lo
Observed Hazards and Mitigation Steps
1
2
3
I
2
3
1
2
3
1
2
3
GP043AS-025822-PP-810
Job Hazard Analysis 3 of 3
JHA REVIEW: Crew Names & Signatures
Printed Name Sionature Date Printed Name Siqnature Date
11 JHA Meetinq & Review
Items to review:
o Change in conditions o Extended work hours o Daily Safety Topic
r New workers or contractors o Occurrence of near misses or injuries
lnitialing demonstrates that site conditions and hazards have not changed from the original SSP. lf changes did occur, make the
necessary updates to this JHA and add notes as applicable in Section 9.
Day Discussion Topic lnitials
2
3
4
5
6
7
I
9
10
11
AOS-FRM-1.18
Page 4L of 47GP043AS-025822-PP-8 10
Page 1 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 prbr to work commencing. ln the event of an emergency situation/
evacuation, the Job Supervisor/ CPM wilt maintain a roster and be responsible for accounting for all employees. The Job Supewisor/
CPM will ensure that this Emergency Action Plan Form is completed, communicated to all employees, and posted.
.Mou must follow the client's emergency action plan first and notify your Supervisor immediately.
.lf incident is life threatening, CAIL 91'l IMMEDIATELLY
.[i non-emergency medical aftention is needed, call AXIOM Medical number: 877-502-9466.
AQS-FRM-1.11
GP043AS-025822-PP-B 10
1 [/lEG Job Supervisor/ GPM'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:
9 Plant's #1 Contact Person's Telephone Number:
10 Plant's #2 Gontact 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 42 of 47
Page 2 of 2
EMERGENCY EVACUATION AND ASSEMBLY MAP
1 Facility Name:
2 Facility Alarm (Circle):YES or NO
3
Alarm Tones:
VTCAL/ GAS:.
.TER.IN-PLACE: ;
4 Designated Shelter(s) Description:
5 Designated Assembly Point(s) Description:
N
*J\uY
s
EMERGENCY ACTION PLAN FORM AND EVACUATION ASSEMBLY MAP REVIEW: Crew Names and Signatures
Printed Name:Siqnature:Date:Printed Ndme:Signature: Date:
AQS-FRM-1.11
GP043AS-025822-PP-810 Page 43 of 47
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
11. 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 manufacturer
recommendations.
Yes
u
tr
n
tr
tr
tr
n
tr
tr
tr
tr
u
tr
tr
!
trtr
No N/A
trD
trtr
trtr
trtr
!n
trn
trtr
trn
!tr
trtr
Dtr
utr
trtr
!!
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-8 10
Date
AQS-FRM-1.16
Page 44 of 47
Signature
a^'I
A- ,1 !{f,t1u & i\tl.xtb&.Page 1 of 't
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 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:
3.
OOlAS-SAFETY-FM.3
Page 45 of 47
The test leader should look for signs of the following in their crews:
. lrritabilityr Lack of motivation. Headaches. Giddiness
r Fatigue. Depression. Reduced alertness, lack of concentration and
memory
The test leader should assess the environmental and hazardous concerns:
GP043AS-025822-PP-810
{t'a
1.
2.
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 Manaoer (PM):Expected Hiqh Temp:
Date(s):Expected Heat !ndex:
Revlew 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-SAFETY-FM-5
Page 46 of 47GP043AS-025822-PP-B 10
.Jtrl.
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] I'TAH DEPARTMENT OF
E}WIRONMENTAL OUALJTY
FEB 28 2024
DIVISION OF AIH QUALITV
GP043AS-025822-PP-8 10 Page 47 of 47