CONSTRUCTION STANDARD SPECIFICATION

SECTION 01563

**[DUST CONTROL]{.underline}**

PART 1 - GENERAL

[1.01 Summary
2](#number-range-level0number-range-level1number-range-level2number-range-level3number-range-level4number-range-level5number-range-level6number-range-level71-summary)

[1.02 References
2](#number-range-level1number-range-level2number-range-level3-references)

[1.03 Definitions
3](#number-range-level1number-range-level2number-range-level3-definitions)

[1.04 Submittals 3](#number-range-level1number-range-level2-submittals)

[1.06 Quality Assurance
4](#number-range-level1number-range-level2-quality-assurance)

PART 2 - PRODUCTS

[2.01 Dust Control Palliatives
4](#number-range-level0number-range-level1number-range-level2number-range-level3number-range-level4number-range-level5number-range-level6number-range-level71number-range-level1number-range-level2-dust-control-palliatives)

PART 3 - EXECUTION

[3.01 Dust Control
5](#number-range-level0number-range-level1number-range-level2number-range-level3number-range-level4number-range-level5number-range-level6number-range-level71number-range-level1number-range-level2-dust-control)

ATTACHMENT A

Checklist for Roadway Development

ATTACHMENT B

Checklist for Structure Demolition

ATTACHMENT C

Checklist for New Construction

ATTACHMENT D

Checklist for Utility Improvement

CONSTRUCTION STANDARD SPECIFICATION

SECTION 01563

**[DUST CONTROL]{.underline}**

# PART 1 - GENERAL

## 1.0Number range level0Number range level1Number range level2Number range level3Number range level4Number range level5Number range level6Number range level71 SUMMARY

A.  Section includes: Requirements, methods, and materials for
    controlling dust and other particulate matter resulting from surface
    disturbance activities, pressure blasting, and demolition.

    1.  Disturbance of ground surface where activity exceeding 3/4 acre.

    2.  Disturbance of paved surface by grinding, milling, or other
        alteration: Surfaces exceeding 3/4 acre.

    3.  Demolition of building: Over 75,000 cubic feet .

    4.  Pressure blasting using sand or other abrasive.

B.  Number range level3Related sections:

    1.  Section 02222, "Selective Demolition": Demolition and removal
        activities to be coordinated with work of this Section.

    2.  Section 02200, "Earthwork": Clearing, grubbing, excavation,
        rough grading, and other surface disturbing activities to be
        coordinated with work of this Section.

## 1.02Number range level1Number range level2Number range level3 REFERENCES

A.  New Mexico Administrative Code (NMAC) - 20 NMAC 11.20:

    1.  Title 20 - Environmental Protection.

    2.  Chapter 11 - Albuquerque/Bernalillo County Air Quality Control
        Board (AQCB).

    3.  Part 20 - Fugitive Dust Control.

## 1.03Number range level1Number range level2Number range level3 DEFINITIONS

A.  Palliative: Agent applied to disturbed soil to mitigate and control
    dust.

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C.  Surface disturbance: Disturbance of ground, soil, or paved surface
    from its pre-existing conditions.

D.  Transported material: Particulate matter moved off-site by wind,
    water erosion, truck spillage, and tracking by vehicles.

## 1.04Number range level1Number range level2 SUBMITTALS

A.  Provide in accordance with Section 01330, "Submittal Procedures":

    1.  A Fugitive Dust Control Application with Parts A and H completed
        for the associated project types (sign as operator in Section
        H):

-   New Building Construction

-   Utility Improvements

-   Structure Demolition/Renovation

-   Roadway Development.

    1.  Submit the Fugitive Dust Control Application to the SNL Air
        Quality Compliance (AQC) Program. This application must be
        submitted for processing by the SNL AQC Program.

    2.  If the project does not fall into one of the above categories or
        if the permit is a programmatic type, then the
        contractor/facilities completes the appropriate construction or
        programmatic application form and submit for processing by the
        AQC Program.

    3.  NOTE: The AQC Program will obtain the Fugitive Dust Control
        Permit from the City of Albuquerque and return the approved
        permit to the Contractor through the Project Manager.

    4.  Description and data for palliatives and other dust control
        materials.

    5.  Two copies of approved Surface Disturbance/Demolition Permit
        required by Paragraph 1.05.A.1. for SDR and for SNL
        Environmental and Emergency Management Department, Surface
        Disturbance Permit Oversight Program.

    6.  Particulate Matter Control Plan required by Paragraph 1.05.A.2
        for review, approval, and signature by SDR.

## 1.05Number range level1Number range level2 QUALITY ASSURANCE

A.  Number range level1Number range level2Number range level3Regulatory
    Requirements

    1.  A complete copy of the Fugitive Dust Control Plan/Permit with
        all maps must be on site prior to beginning construction
        activity and all documents must be retained on-site at all times
        during project construction.

    2.  All reasonably available control measures listed in permit must
        be followed during the project..

        a.  Comply with requirements of 20 NMAC 11.20.

        b.  

        c.  Comply with special requirements of Albuquerque Air
            Pollution Control Division.

        d.  

        e.  Number range level3Coordinate time for obtaining required
            permits and approvals with Project schedule. Assume
            responsibility for delays caused by resubmittal and
            revocation of permits for non-compliance.

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A.  Dust palliative: Prior to submittal of Surface
    Disturbance/Demolition Permit application to SDR for approval, apply
    proposed dust palliative to test strip at job site. Demonstrate to
    SDR suitability of palliative to control dust.

# PART 2 - PRODUCTS

## 2.0Number range level0Number range level1Number range level2Number range level3Number range level4Number range level5Number range level6Number range level71Number range level1Number range level2 DUST CONTROL PALLIATIVES

A.  Acceptable types:

    1.  Resinous petroleum based emulsion not harmful to plants; Coherex
        as manufactured by Witco.

    2.  Penetration emulsion prime coat based on 38 percent minimum AC-5
        asphalt cement: PEP as manufactured by Southwest Emulsions.

    3.  Prime dust oil emulsion based on 50 percent minimum AC-10
        asphalt cement; PDOK as manufactured by Chevron USA.

    4.  Other type agent to mitigate dust as approved by SDR.

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B.  Number range level3Formulation, dilution, and application rate: As
    recommended by manufacturer for specific soils at Project site.

# PART 3 - EXECUTION

## 3.0Number range level0Number range level1Number range level2Number range level3Number range level4Number range level5Number range level6Number range level71Number range level1Number range level2 DUST CONTROL

A.  Implement approved Particulate Matter Control Plan specified in
    Paragraph 1.05.A.2. Coordinate with work of Section 02200,
    "Earthwork" and Section 02222, "Selective Demolition".

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C.  Use method or combination of methods listed below and approved by
    SDR to prevent particulate matter from becoming airborne and being
    transported off-site:

    1.  Phasing: Only disturb areas less than one acre at one time.
        Begin construction activities at west side of site and proceed
        to east to provide buffer area where shifting soil can be
        arrested.

    2.  Schedule: Delay earthwork and other activities generating
        particulate matter until wind velocity is 30 MPH maximum.

    3.  Restricting vehicles: Use signs and other traffic controls to
        limit speed and access of job site vehicles. Limit speed to 10
        MPH maximum. Restrict vehicle traffic in dust stabilized areas.

    4.  Excavated material: Keep out of active traffic lanes.
        Immediately remove excavated material deposited in roadways by
        erosion or spillage. Cover loads transported in earth-moving
        equipment.

    5.  Watering: Use sprinkler system or water truck with spray boom to
        water disturbed area daily and at intervals required to
        adequately control dust.

    6.  Windbreaks: Erect snow fences or similar windbreaks upwind and
        within disturbed areas. Place fences perpendicular to prevailing
        winds.

    7.  Palliatives: Apply dust palliative to stabilize soils after
        earthwork is completed and to sandy soils where watering is
        ineffective. Do not use palliative detrimental to vegetation in
        areas of future plant landscaping.

    8.  Other methods that substantially and effectively reduce
        transported material or emission of particulate matter into
        atmosphere.

END OF SECTION

**[ATTACHMENT A]{.underline}**

CHECKLIST FOR ROADWAY DEVELOPMENT

![](media/image2.png){width="0.8791338582677165in"
height="0.8019685039370079in"}**[[Albuquerque Environmental Health
Department - Air Quality Division
(Department)]{.underline}]{.smallcaps}**

**[[11850 Sunset Gardens SW - Albuquerque, New Mexico
87121]{.underline}]{.smallcaps}**

**[[(505) 768 - 1972 (Voice) (505) 768 - 2482 (TTY) (505) 768 - 1977
(Fax)]{.underline}]{.smallcaps}**

[Application for a Fugitive Dust Control Permit in Bernalillo
County]{.smallcaps}

[Albuquerque - Bernalillo County Air Quality Control Board Regulation
20.11.20 NMAC]{.smallcaps}

[Construction Permit for Surface Disturbance/Demolition]{.smallcaps}

**[[Division Receipt Stamp Below this line]{.underline}]{.smallcaps}**
[Effective Date Of This Form: 3/1/05]{.smallcaps}

> [submittal date/time]{.smallcaps}
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[received by]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[permit \#]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project Information
and General Activities (20.11.20.15 NMAC)]{.underline}]{.smallcaps}**
**([Print or Type]{.smallcaps})**

**1.** [Project Name]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** [Project Location]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[submit as an attachment to this application, an 8 ½" x 11" or larger
site map or plat of project location]{.smallcaps}**

**3.** [Project Street Address]{.smallcaps} (if available)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** [Major Cross Streets or Intersection Nearby]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** [Uniform Property Code]{.smallcaps}([s]{.smallcaps}) (if
available):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**6.** [Latitude/Longitude]{.smallcaps} (if available):
[North]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"
[West]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"

**7.** [Universal Transverse Mercator]{.smallcaps} (UTM Coordinates), if
available:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Northing]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Easting]{.smallcaps}

**8.** [Scope of Project (]{.smallcaps}check all that
apply[):]{.smallcaps} □[new building]{.smallcaps}(s)
[construction]{.smallcaps} □[subdivision development]{.smallcaps}
□[utility improvements]{.smallcaps}

□[structure demolition/renovation]{.smallcaps} **[X]{.mark}** [[roadway
development]{.smallcaps}]{.mark} □[other]{.smallcaps} (please describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** [Active Operations (]{.smallcaps}check all that
apply[):]{.smallcaps} □[surface disturbance]{.smallcaps} [□bulk material
hauling or handling]{.smallcaps} [□unpaved roads]{.smallcaps}

[□paved roads]{.smallcaps} [□utility removal/installations]{.smallcaps}
[□structure demolition/renovation]{.smallcaps}
[□milling/grinding/cutting of surfaces]{.smallcaps}

[□other]{.smallcaps} (please describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** [Total Area To Be Disturbed]{.smallcaps} (acres or square
feet)\_\_\_\_\_\_\_\_\_acres;\_\_\_\_\_\_\_\_ft^2^, or, [for Demolition:
Total Cubic Feet]{.smallcaps} \_\_\_\_\_\_\_\_ft^3^

**NOTE: A Fugitive Dust Control Permit application is required for a
Building Demolition Project of** **[over 75,000 ft^3^]{.underline}**
**and must be received by the Department** **[10 business
days]{.underline}** **(Monday through Friday except holidays) before the
anticipated project start date. Asbestos Notification for
demolition/renovation of any commercial building, residential building
of 5 or more dwellings, or residential structure to be demolished to
build a non-residential structure must be received by the Department,
using a separate form,** **[10 working days]{.underline}** **(calendar
days) before the anticipated project start date. Building Demolitions in
Bernalillo County require Department signatures for dust control and
asbestos notification before a demolition permit will be issued by the
City or County.**

**11.** [A Fugitive Dust Control Permit application, for Total Area To
Be Disturbed of]{.smallcaps} [¾]{.smallcaps} [acre up to 25 acres, must
be received by the Air Quality Division]{.smallcaps} [[10 business
days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date. A Fugitive Dust Control Permit application, for Total Area To Be
Disturbed of more than 25 acres, must be received by the Air Quality
Division]{.smallcaps} [[20 business]{.underline}]{.smallcaps}

[[days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date.]{.smallcaps} **[Anticipated Project Start Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**12.** [An approved Fugitive Dust Control Permit shall be valid for 1
year from the date of approval by the Department or the Anticipated
Project Completion Date, whichever is longer, but no more than 5 years.
if the Scope of Project, Active Operations, Expiration Date, Total Area
To Be Disturbed, or Control Measure(s) change in any manner that are
determined by the Department to require additional conditions, then a
new Fugitive Dust Control Permit shall be required.]{.smallcaps} [[A
fugitive dust control permit may be renewed if the department receives a
written request from the permittee 10 business days
prior]{.underline}]{.smallcaps}

[[to expiration date.]{.underline}]{.smallcaps} **[Anticipated Project
Completion Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project
Information]{.underline}]{.smallcaps}** [[&]{.underline}]{.smallcaps}
**[[General Activities (20.11.20.15 nmac)
(continued)]{.underline}]{.smallcaps}**

**13.** ([check one box) active operations will be the total area to be
disturbed]{.smallcaps} □[,]{.smallcaps} [**[OR]{.underline}**, active
operations will be phased]{.smallcaps} □

**14.** [If phasing of active operations]{.smallcaps} (Explain Phasing
Plan and include Total Disturbed Area, in acres, at any given time)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**15.** [Is a site drainage plan required for this project]{.smallcaps}?
[yes]{.smallcaps}\_\_\_\_\_ [no]{.smallcaps}\_\_\_\_\_\_

**16.** [If yes to]{.smallcaps} **[#15]{.smallcaps}** [above, is
drainage plan approved and available upon request by the
department]{.smallcaps}? [yes]{.smallcaps}\_\_\_\_\_\_
[no]{.smallcaps}\_\_\_\_\_\_\_

**17.** [Expected volume of bulk material (on site fill, imported fill,
base coarse gravel, Etc.) to be handled during the duration]{.smallcaps}

[of this project]{.smallcaps} (in cubic yards)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**18.** [Volume of bulk material to be imported to this project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**19.** [Address of Location]{.smallcaps}([s]{.smallcaps}) [from which
bulk material will be imported to this project
site]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**20.** [Do the bernalillo cnty. locations, providing bulk material to
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**21.** [Volume of bulk material to be exported from project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**22.** [Address of location(s)]{.smallcaps} [in bernalillo cnty. that
will receive bulk material exported from this project
site\_\_]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**23.** [Do the bernalillo cnty. locations, receiving bulk material from
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23
nmac)]{.underline}]{.smallcaps}** **The "PERMITTEE" shall include in the
permit application one or more of the applicable reasonably available
control measures given in Part B.1 -- B.12 below,** **[OR]{.underline}**
**one or more other (alternative) fugitive dust control measures,
including measures taken to comply with any other statute or regulation
that would also effectively control fugitive dust during active and
inactive operations or construction activity** **(20.11.20.23 NMAC).**

**NOTE: If the "PERMITTEE" chooses to submit, as an attachment to this
application, an alternative fugitive dust control plan** **[in lieu of
the control measures given in Part B.1 -- B.12 below]{.underline}, the
alternative fugitive dust control plan (such as a storm water pollution
prevention plan) must include detailed information that addresses: 1)**
**the steady ongoing Reasonably Available Control Measures to mitigate
the release of Fugitive Dust from Active and Inactive Disturbed Surface
Areas; and 2) fugitive dust control Contingency Measures that will be
used; and 3) action(s) to be taken to mitigate property damage (see Part
C of this application). If submitting an alternative fugitive dust
control plan you still must complete and initial Parts** **[A, D, E, F,
G, H]{.smallcaps}, and** **[I]{.smallcaps}** **(if utilized) of this
application.**

**1.** **[Unpaved roadways]{.underline}** **\[check applicable
box(es)\]:**

a.□ paving using recycled asphalt, asphaltic concrete, concrete, or
petroleum products legal for such use;

> b.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}
>
> c\. **X** using wet suppression;
>
> d\. **X** using traffic controls, including decreased speed limits
> with appropriate enforcement; other traffic calming methods, vehicle
> access restrictions and controls; road closures or barricades; and
> off-road vehicle access controls and closures;
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** **[Paved roadways]{.underline}** **\[check applicable
box(es)\]:**

> a\. **X** cleaning up spillage and track out as necessary to prevent
> particulates from being pulverized and entrained into the atmosphere;
>
> b.□ using paved or gravel entry/exit aprons with devices, such as
> steel grates, capable of knocking mud and bulk material off vehicle
> tires;
>
> c.□ using on-site wheel washes;
>
> d.□ performing regularly scheduled vacuum street cleaning or wet
> sweeping with a sweeper certified by the manufacturer to be efficient
> at removing particulate matter having an aerodynamic diameter of less
> than 10 microns (i.e. PM~10~);
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**3.** **[Trucks hauling bulk materials on public and private
roadways]{.underline}** **\[check applicable box(es)\]:**

> a\. **X** using properly secured tarps or cargo covering that covers
> the entire surface area of the load;
>
> b.□ preventing leakage from the truck bed, sideboards, tailgate, or
> bottom dump gate;
>
> c.□ using wet suppression to increase moisture content of the bulk
> materials being hauled;
>
> d.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}
>
> e.□ maintaining a minimum of 6 inches of freeboard below the rim of
> the truck bed. Freeboard means the vertical distance from the highest
> portion of the load abutting the bed and the lowest part of the top
> rim of the truck bed abutting the load;
>
> f.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Short term** control measures shall include (check this box
> first if utilizing short term measures listed below):

a\. **X** wet suppression;

> b.□ dust suppressants applied in amounts, rates, and maintained as
> recommended by the manufacturer; [submit manufacturer's information as
> an attachment to this application]{.smallcaps}
>
> c.□ temporary upwind windbreaks, including fabric fences with the top
> at least 4 feet above grade, and with the bottom of the fence
>
> sufficiently anchored to the ground to prevent material from blowing
> underneath the fence; all windbreaks and fabric fences shall be
> maintained in an upright and functional condition at all times until
> no longer needed to prevent or abate fugitive dust; all accumulated
> material on the windward side of the windbreak shall be periodically
> removed to prevent failure of the windbreak;
>
> d.□ watering the site at the end of each workday sufficient to
> stabilize the work area;
>
> e.□ applying dust suppressants in amounts and rates recommended by the
> manufacturer on the worksite at the end of each work week if no active
> operations are going to take place over the weekend or if active
> operations stop for more than two consecutive days;
>
> f.□ starting construction at the location that is upwind from the
> prevailing wind direction and stabilizing disturbed areas before
> disturbing additional areas;
>
> g.□ clean up and removal of track-out material;
>
> h.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Long term** control measures shall include (check this box
> first if utilizing long term measures listed below):
>
> a.□ site stabilization using dust suppressants applied in amounts and
> rates recommended by the manufacturer and maintained as recommended by
> the manufacturer; [submit manufacturer's information as an attachment
> to this application]{.smallcaps}

b.□ reseeding using native grasses as specified in 20.11.20.24 NMAC --
[native grass seeding and mulch specifications]{.smallcaps};

c.□ xeriscaping;

> d.□ installing parallel rows of fabric fencing or other windbreaks set
> perpendicular to the prevailing wind direction either onsite or on a
> nearby property with the permission of the nearby property owner;

e.□ surfacing with gravel or other mulch material of a size and density
sufficient to prevent surface material from becoming airborne;

f.□ mulching and crimping of straw or hay as specified in Section
20.11.20.24 NMAC;

g.□ installing permanent perimeter and interior walls;

h.□ conventional landscaping techniques;

i\. **X** clean up and removal of track-out material;

j\. **X** other (alternative) \_\_**Restrict access to inactive areas to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**6.** **[Bulk material handling]{.underline}** **\[check applicable
box(es)\]:**

a.□ using spray bars;

b.□ applying wetting agents (surfactants) to bulk material;

c.□ using wet suppression through manual or mechanical application;

> d.□ adding dust suppressants to bulk materials in amounts and rates
> recommended by the manufacturer and maintained as recommended by the
> manufacturer; [submit manufacturer's information as an attachment to
> this application]{.smallcaps}

e.□ reducing process speeds;

f\. **X** reducing drop heights;

g.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**7.** **[Industrial sites]{.underline}** **\[check applicable
box(es)\]:** **NA**

a.□ paving roadways and parking area with recycled asphalt, asphaltic
concrete, concrete, or petroleum products legal for such use;

b.□ performing regularly scheduled vacuum street cleaning or wet
sweeping;

c.□ regularly using wet suppression on unpaved areas;

> d.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

e.□ installing wind breaks;

f.□ installing enclosures;

> g.□ installing on-site anemometers to measure wind speed; the
> anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify on-site personnel of high winds;

h.□ increasing wet suppression applications before and during high wind
conditions;

i.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**8.** **[Demolition/renovation activities ([NON-asbestos containing
materials present]{.smallcaps})]{.underline}** **\[check applicable
box(es)\]:** **NA**

a.□ using constant wet suppression on the debris piles during
demolition;

> b.□ using water or dust suppressants on the debris pile, applied in
> amounts and rates recommended by the manufacturer; [submit
> manufacturer's information as an attachment to this
> application]{.smallcaps}

c.□ using enclosures;

d.□ using curtains or shrouds;

e.□ using negative pressure dust collectors;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** **[Milling, grinding or cutting of paved or concrete
surfaces]{.underline}** **\[check applicable box(es)\]:**

a\. **X** constantly using wet suppression;

b.□ ongoing clean up of milled, ground or cut material by using wet
sweeping;

> c.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

d.□ using enclosures;

e.□ using curtains or shrouds;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** **[Pressure blasting operations]{.underline}** **\[check
applicable box(es)\]:** **NA**

a.□ using non-friable abrasive material;

b □ using curtains, enclosures or shrouds;

c.□ using negative pressure dust collectors;

d.□ using constant wet suppression;

e.□ maintaining ongoing clean up of abrasive material;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**11.** **[Spray painting and other coatings]{.underline}** **\[check
applicable box(es)\]:** **NA**

a.□ using enclosures that comply with applicable fire codes;

b.□ using curtains, enclosures or shrouds;

c.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**12.** **[High wind contingency measures]{.underline}** **\[check
applicable box(es)\]:**

**NOTE: It is required during a high wind event ([5 consecutive minutes
with an average wind speed of 30 miles per hour or higher]{.underline})
that** **[ALL]{.underline}** **fugitive dust sources cease all active
operations that are capable of producing fugitive dust; and continue to
use reasonably available control measures; and implement high wind
contingency measures.**

> a.□ installing and using on-site anemometers to measure wind speed;
> the anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify site personnel of high winds;

b\. **X** using constant wet suppression;

> c.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}

d.□ using wetting agents or surfactants on disturbed areas, bulk
materials or stockpiles;

e.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART C. -]{.underline}** **[[fugitive dust
control plan (plan) (20.11.20.14 nmac)]{.underline}]{.smallcaps}**
**[(Print or Type)]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The "PERMITTEE" is required to comply with a
Fugitive Dust Control Plan that** **[details]{.underline}** **the
Fugitive Dust Control Measures that will be used to mitigate the release
of Fugitive Dust from Active and Inactive Disturbed Surface Areas. This
includes: 1) steady ongoing Reasonably Available Control Measures; and
2) fugitive dust control Contingency Measures; and 3) action(s) that
will be taken to mitigate claims of property damage.** **[[If you are
not]{.underline}]{.smallcaps}** **[submitting as an attachment to this
application an alternative fugitive dust control plan, then you must
complete Part C.1 - C.3 below to complete your Fugitive Dust Control
Plan.]{.smallcaps}**

**1**. [Describe in detail the steady ongoing]{.smallcaps} [Reasonably
Available Control Measures that you may have selected in Part B.1 --
B.12 of this application that will be used during this project to
mitigate the release of Fugitive Dust from Active Disturbed Surface
Areas (]{.smallcaps}any [current]{.underline} operation capable of
creating dust[) and Inactive Disturbed Surface Areas
(]{.smallcaps}previously disturbed areas where active operations are
temporarily suspended[). (]{.smallcaps}Some examples are: Provide
detailed information that may include the type, size and quantity of
equipment that will be used for wet suppression, and frequency of use;
Type of traffic control that will be used; Type and locations of fencing
or walls that will be installed; Type and frequency of use of vacuum or
wet sweeping that will be used; Location and type of temporary pavements
that will be used; Seeding plan; etc.).

[Active]{.smallcaps} -\_\_**Water trucks will be used to provide wet
suppression or connection to fire hydrant if
available**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Limit traffic flow at inactive sites to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**2**. [Describe in detail the additional fugitive dust control
Contingency Measures that will be used during this project if the
Reasonably Available Control Measures chosen in Part]{.smallcaps} b.[1
-- B.12 and detailed in Part C.1 above are determined by the department
to be insufficient to provide adequate Fugitive Dust
Control]{.smallcaps} [during Active and Inactive
Operations.]{.smallcaps}

[Active]{.smallcaps} -\_\_\_**Reduce speed of heavy equipment hauling
operations; wet areas to be disturbed prior to
operations**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Restrict traffic on inactive
areas**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**3**. [Describe the action(s) that will be taken to mitigate claims of
property damage by fugitive dust generated at/from this
project]{.smallcaps}. **[It is required to remedy damage to real
properties caused by a violation of the permit (20.11.20.12.C
nmac).]{.smallcaps}**

\_\_\_**Will respond to reasonable claims of property damage. Will
provide for cleanup and/or repairs of affected
property**\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART - D. -]{.underline}** **[[high wind event
(20.11.20.16 nmac)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[NOTE]{.smallcaps}: A high wind event is a time period of 5
consecutive minutes with an average wind speed of 30 miles per hour or
higher.** **[ALL]{.underline}** **fugitive dust sources shall cease all
Active Operations that are capable of producing fugitive dust; and
continue to use Reasonably Available Control Measures; and implement
high wind contingency measures during a High Wind Event.**

**1**. [Describe in detail how the High Wind Contingency Measure(s)
chosen will be used during this project]{.smallcaps}\_\_\_**Cease
operations and maintain watering of site**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART -- E. -]{.underline}** **[[high wind
affirmative defense (20.11.20.16 nmac)]{.underline}]{.smallcaps}**

**[ATTENTION !!!]{.smallcaps}**

**[To assert a high wind affirmative defense,]{.smallcaps}** **[[the
permittee agrees to use one of the three]{.underline}]{.smallcaps}**
**[[Mandatory Control Measures shown below throughout the entire
duration of the permit]{.underline}, regardless of whether or not a high
wind event exists.]{.smallcaps}**

**[Do you wish to qualify for a High Wind Affirmative Defense during the
duration of this permit]{.smallcaps}?** **[yes]{.smallcaps}\_\_\_\_**
**[no]{.smallcaps}\_X\_\_**

**[If the answer to the above question is YES, then choose one of the
required Control Measures]{.smallcaps}** **[shown below]{.smallcaps}**

> 1[.]{.smallcaps}□ Using wet suppression sufficient to provide and
> maintain a soil moisture content of not less than 12 percent, and
> using properly maintained fabric fencing material around the perimeter
> of the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high); and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 2.□ Using chemical dust suppressants, in amounts and rates recommended
> by the manufacturer, sufficient to substantially reduce fugitive dust
> leaving the project area while Active Operations are idle, and using
> properly maintained fabric fencing material around the perimeter of
> the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high), and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 3.□ Using an alternative dust control measure or measures that provide
> fugitive dust control that is equal to or better than using the
> measures described in options E.1 or E.2 above; and during a High Wind
> Event ceasing all Active Operations but continuing to use all control
> measures. If you choose to qualify for a High Wind Affirmative Defense
> and are selecting E.3, submit as an attachment the alternative dust
> control measure or measures for Department approval.

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac)]{.underline}]{.smallcaps}** **[(Print or Type)]{.smallcaps}**

[At the time of submittal, any person filing an application for a
Fugitive Dust Control Permit shall pay the applicable fees required. No
application will be reviewed or permit issued unless all applicable fees
have been paid. Construction Permits for Surface Disturbance require a
Filing & Review Fee, and an Inspection Fee.]{.smallcaps}

**[1. FILING & REVIEW FEE TABLE]{.smallcaps}**

  -------------------------------- -------------------- --------------------
  **[Total project acreage to be   **[filing & review   **[Check Appropriate
  disturbed]{.smallcaps}**         Fee]{.smallcaps}**   Box]{.smallcaps}**

  **¾ acre to less than 2 acres**  **\$250.00**         

  **2 acres to less than 5 acres** **\$350.00**         

  **5 acres to less than 15        **\$450.00**         
  acres**                                               

  **15 acres or greater**          **\$550.00**         
  -------------------------------- -------------------- --------------------

**NOTE:** **[the permittee shall install and maintain a project sign,
issued or approved by the Department, for all fugitive dust control
projects of 10 or more acres.]{.smallcaps}**

**[Inspection Fee[:]{.smallcaps}]{.underline}** **[-]{.smallcaps}** **To
calculate the fugitive dust control Inspection Fee below, which is in
addition to the above Filing & Review Fee, multiply the total project
acreage to be disturbed by the per - acre rate shown in the table below.
The total project acreage to be disturbed, used to calculate the
Inspection Fee below, must be expressed as a whole number. When
rounding, if the number after the decimal point is less than 5, the
whole number remains unchanged. If the number after the decimal point is
5 or greater, the whole number shall be rounded up to the next whole
number. Rounding of acres shall occur before the Inspection Fee is
calculated.**

2\. INSPECTION FEE TABLE

+--------------------------+----+---------------+---+------------------+
| **[Total project acreage | *  | **[Per Acre   |   | **[Inspection    |
| to be                    | *[ | Rate]{        |   | Fe               |
| disturbed]{.smallcaps}** | Ti | .smallcaps}** |   | e]{.smallcaps}** |
|                          | me |               |   |                  |
| **[(rounded to nearest   | s] | **[(based on  |   |                  |
| whole                    | {. | 20.11.2.15    |   |                  |
| number)]{.smallcaps}**   | sm | nmac)]{       |   |                  |
|                          | al | .smallcaps}** |   |                  |
|                          | lc |               |   |                  |
|                          | ap |               |   |                  |
|                          | s} |               |   |                  |
|                          | ** |               |   |                  |
+--------------------------+----+---------------+---+------------------+
|                          | *  | **\$100.00**  | * | **\$**           |
|                          | *x |               | * |                  |
|                          | ** |               | = |                  |
|                          |    |               | * |                  |
|                          |    |               | * |                  |
+--------------------------+----+---------------+---+------------------+

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac) (continued)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[[Total Project Fee]{.underline}]{.smallcaps}** -- [Add the Filing &
Review Fee and the Inspection Fee from page 6 to determine the Total
Project Fee to be submitted with this application for a Fugitive Dust
Control Permit.]{.smallcaps}

3\. TOTAL PROJECT FEE TABLE

  ----------------------- ------------------------ ------------------------ ------- --------------------
  **[Filing & Review      **[Plus]{.smallcaps}**   **[Inspection                    **[Total Project Fee
  Fee]{.smallcaps}**                               Fee]{.smallcaps}**               Due]{.smallcaps}**

  \$                      **+**                    \$                       **=**   \$
  ----------------------- ------------------------ ------------------------ ------- --------------------

**NOTE: If an application to obtain a fugitive dust control permit is
submitted after active operations have commenced at the project
location, a late fee of 50 percent of the total project fee shall be
assessed in addition to the total project fee (20.11.2.17**
**[nmac).]{.smallcaps}** **In addition to this late fee for application
processing and permit issuance[,]{.smallcaps}** **civil penalty's may be
assessed** **pursuant to the New Mexico Air Quality Control Act, Chapter
74, Article 2 New Mexico Statutes Annotated 1978.**

**[Use the calculation below only if you are required to submit a late
fee.]{.smallcaps}**

**[Total Project Fee Due:]{.smallcaps}** **[\$]{.smallcaps}** **[X (1.5)
late fee factor =]{.smallcaps}** **[\$]{.smallcaps}** **[Total
Project/late Fee Due]{.smallcaps}**

**NOTE: Total Project Fee Due OR Total Project/Late Fee Due, required to
be paid at the time of application submittal, shall be paid by check or
money order payable to:** **[City of Albuquerque, Permits Program (Fund
242 -- Account \# 0421425)]{.underline}.** **Application and
accompanying fee may be delivered by mail to the address that appears at
the top of page 1 of this form or hand delivered to the same address
(between the hours of 8:00 am - 4:30 pm Mon. through Fri.). Call
768-1972 if hand delivering application and fee to insure that
appropriate staff is available to process a receipt.**

**[[PERMIT APPLICATION PART -- G. -- signature authority of permittee
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

**[NOTE:]{.smallcaps}** **This application shall include a fugitive dust
control plan that may utilize reasonably available control measures to
mitigate fugitive dust to meet the Objectives of Part 20.11.20 NMAC --
Fugitive Dust Control.** **By signing below, the applicant certifies
that the information provided in this application for a Fugitive Dust
Control permit is true, accurate and complete, and the applicant agrees
to be the "PERMITTEE". A "PERMITTEE" is a person, owner or operator and
all legal heirs, successors, and assigns who has applied for and
obtained a fugitive dust control permit approved by the Department. The
"PERMITTEE" agrees to take all actions required by the Fugitive Dust
Control permit issued by the Department to prevent a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping active
operations, if necessary.** **[The "PERMITTEE" is responsible for
complying with the fugitive dust control permit, the fugitive dust
control plan, and all requirements of Part 20.11.20 NMAC.- Fugitive Dust
Control. Failure to comply shall be a violation of Part 20.11.20 NMAC --
Fugitive Dust Control.]{.underline}**

[THE PERMITTEE SIGNATURE BOX MUST BE COMPLETED (**complete all
applicable information)**]{.smallcaps}

[\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print permittee's Business Name Email Address of Permittee Fax Number
of Permittee]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone Number of Permittee Cell Phone of Permittee Pager Number of
Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Permittee CITY State zip code]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Permittee]{.smallcaps} [Print
Title of Individual Signing for Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee]{.smallcaps} [Initials of Permittee]{.smallcaps}
[Date Submitted]{.smallcaps}

**[it is the responsibility of the permittee or designated responsible
person or official to ensure that the fugitive dust control permit or
amended permit contains current contact information and that
a]{.smallcaps}** **[[copy is maintained at the work site and is provided
to the department.]{.underline}]{.smallcaps}** **[failure to maintain
and provide up-to-date contact information shall be a violation of this
part. (20.11.20.18g nmac).]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The applicant signing above and applying to be
the "Permittee", may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined in 20.11.20.7CC
NMAC (definitions), if the person(s) agrees in writing to be a
responsible person. A Responsible Person can be the Permittee, the
Owner, the Operator, or another Person(s). Before Department review and
issuance of a fugitive dust control permit, if the Permittee wishes to
designate a person(s) as a responsible person(s) for complying with all
or specific elements of the fugitive dust control permit, the fugitive
dust control plan, and Part 20.11.20 NMAC.- Fugitive Dust Control, then
Section I - signature authority of "Responsible Person" may be used at
the time of application submittal and must include all applicable
information concerning the designated Responsible Person(s). After the
issuance of the permit, the Department may approve in writing a permit
amendment to add or change a designated responsible person(s).
(20.11.20.14B NMAC)**

**[[PERMIT APPLICATION PART -- H. -- Owner or Operator Information
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

Complete the owner and/or operator information below [ONLY IF DIFFERENT
THAN THE PERSON WHO HAS SIGNED AS THE PERMITTEE IN SECTION
G]{.underline}, OR as a responsible person(s) in Section I of this
application for a fugitive dust control permit.

**[NOTE:]{.smallcaps}** **If the Permittee fails to comply with the
provisions of 20.11.20 NMAC -- Fugitive Dust Control, the Owner or
Operator, if different from a Responsible Person or the Permittee, shall
be responsible for complying with the permit. If the Permittee fails to
take all required actions to prevent a violation of 20.11.20 NMAC --
Fugitive Dust Control, the Owner or Operator or designated Responsible
Person, if different than the Permittee, shall be responsible to take
all actions required to prevent or satisfactorily resolve a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping all active
operations, if necessary. To mitigate fugitive dust, all Inactive
Disturbed Surface Areas must be stabilized and maintained in stable
condition by the Owner, Operator, OR Person responsible for maintenance
of the disturbed surface. Failure to comply shall be a violation of
20.11.20 NMAC -- Fugitive Dust Control (20.11.20.12 NMAC).**

**[PROJECT O[WNER INFORMATION]{.smallcaps}]{.underline}** [(**complete
all applicable information)**]{.smallcaps}

[\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Owner's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Owner]{.smallcaps} [Print
Title of Individual Signing for Project Owner]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Owner]{.smallcaps} [Initials of Project
Owner]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Owner City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Owner Cell of Project Owner Pager of Project Owner Fax
of Owner]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Owner]{.smallcaps}

The **GENERAL PROVISIONS** of 20.11.20 NMAC -- Fugitive Dust Control
states that no person shall allow fugitive dust, track-out, or
transported material from any active operation, open storage pile, paved
or unpaved roadway or disturbed surface area, or inactive disturbed
surface area to be carried beyond the property line, right-of-way,
easement or any other area under the control of the person generating or
allowing the fugitive dust if the fugitive dust will: 1) adversely
affect the health, public welfare or safety of the residents of
Bernalillo county; or 2) impair visibility or the reasonable use of
property; or 3) be visible longer than a total of 15 minutes in any 1
hour observation period using the visible fugitive dust detection method
in 20.11.20.26 NMAC (visual determination of fugitive dust emissions
violations) or an equivalent method approved in writing by the
department.

**[project]{.underline}** **[[OPERATOR
INFORMATION]{.underline}]{.smallcaps}** [(**complete all applicable
information)**]{.smallcaps}

[\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Operator's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Operator]{.smallcaps}
[Print Title of Individual Signing for Project Operator]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Operator]{.smallcaps} [Initials of Project
Operator]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Operator City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Operator Cell of Project Operator Pager of Project
Operator Fax of Project Operator]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Operator]{.smallcaps}

**[[PERMIT APPLICATION PART -- I. -- signature authority of "Responsible
Person" (20.11.20.14 nmac)]{.underline}]{.smallcaps}** **[-
"]{.smallcaps}Responsible Person" means the person designated in a
permit who is responsible for complying with the permit, plan and
20.11.20 NMAC -- Fugitive Dust Control, to the extent specified in the
permit.**

**NOTE: If more than 1 individual will be designated a responsible
person at the time of this application submittal, make photocopies of
this page before completing any information. After the issuance of the
permit, the department may approve in writing an amendment to the permit
to add or change a designated responsible person(s).**

**The Permittee, may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined above. If
different then the Permittee, a person that agrees in writing to be a
responsible person will be liable for violations of the permit, plan and
Part 20.11.20 NMAC -- Fugitive Dust Control and shall be the first
person contacted by the Department to resolve a violation of the permit
or Part 20.11.20 NMAC to the extent outlined below in the 'Active
Operation responsibilities** **of individual signing as a Responsible
Person' \[activity(ies)\][.]{.smallcaps}**

[\_\_\_\_\_\_\_\_**na**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Responsible person's Business Name Print Name of individual
signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Title of individual signing as a Responsible Person Date
Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of individual signing as a Responsible Person]{.smallcaps}
[Initials of individual signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

[address of individual signing as a Responsible Person City State Zip
Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of individual signing as a Responsible Person Cell of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Pager of individual signing as a Responsible Person Fax of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email of individual signing as a Responsible Person Active Operation
responsibilies of individual signing as a Responsible
Person]{.smallcaps} **[\[activity(ies)\]]{.smallcaps}**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee approving the designation of above individual as
a responsible person Date Signed]{.smallcaps}

**[NOTE:]{.smallcaps}** **By signing above as a Responsible Person you
will be designated in the permit issued by the Department as responsible
for complying with the permit, plan and Part 20.11.20 NMAC -- Fugitive
Dust Control to the extent specified in the above \[activity(ies)\]. You
will be responsible for the above \[activity(ies)\] for the duration of
the permit OR until such time as the Department receives a request from
the permittee to remove you from being the responsible person for the
above \[activity(ies)\]. The Permittee will become the responsible
person for the \[activity(ies)\] that a responsible person is removed
from, unless a new responsible person is designated for the same
\[activity(ies)\] and approved by the Department in writing.**

**[NOTE:]{.smallcaps}** **The Permittee or responsible person shall**
**[[maintain a current copy of the permit at the work
site]{.underline}]{.smallcaps}** **and make the permit available and
explain the requirements of the permit to appropriate employees, agents,
contractors, and any other person performing work in the area of active
disturbance to assist in maintaining compliance with Part 20.11.20 NMAC
-- Fugitive Dust Control.**

**[Pursuant to the Air Quality Control Act, Chapter 74, Article 2 New
Mexico Statutes Annotated 1978, as amended; the Albuquerque Joint Air
Quality Control Board Ordinance, 9-5-1-1 ROA 1994; the Bernalillo County
Joint Air Quality Control Board Ordinance, Bernalillo County Ordinance
94-5, and the Albuquerque/Bernalillo County Air Quality Control Board
(A/BCAQCB) Regulation Title 20, Chapter 11, Part 20, New Mexico
Administrative Code (NMAC), (20.11.20 NMAC) - Fugitive Dust Control, and
upon authorized signatures below, this application together with
associated drawings, plans, appended documents, other data, and any
conditions attached to the permit by the Department, will become the
Fugitive Dust Control Permit. Table Below For Department
Use.]{.smallcaps}**

+-------------------+---------+-------------------+---------+--------+
| **[application    | **[     | **[permit issued  | *       | **[e   |
| reviewed          | deemed] | b                 | *[issue | xpirat |
| b                 | {.small | y:]{.smallcaps}** | date]   | ion]{. |
| y:]{.smallcaps}** | caps}** |                   | {.small | smallc |
|                   |         |                   | caps}** | aps}** |
|                   | **[co   |                   |         |        |
|                   | mplete] |                   |         | **[d   |
|                   | {.small |                   |         | ate]{. |
|                   | caps}** |                   |         | smallc |
|                   |         |                   |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+

**[[PERMIT APPLICATION PART -- J. -- transfer of fugitive dust control
permit and plan (20.11.20.14 nmac)]{.underline}]{.smallcaps}**

**[attention: use this signature page only if transferring complete
responsibility of a current fugitive dust control permit and plan to a
new permittee.]{.underline}**

**[a fugitive dust control permit and plan may be transferred to legal
heirs, successors, and assigns, who shall become the new permittee.
transfers may be made as an administrative amendment provided
that:]{.smallcaps}**

**[1) a written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[is drafted between the current
and new permittee, and the project owner; and]{.smallcaps}**

**[2) a specific date is established for the transfer of the permit and
plan responsibility, coverage, and liability; and]{.smallcaps}**

**[3) department approval of written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[has been
authorized.]{.smallcaps}**

**[there is no cost for transfer of the fugitive dust control permit and
plan if determined by the department that only administrative change is
needed. however, new application information must be submitted by the
new permittee or owner along with any applicable fees, if determined by
the department that necessary changes are required to complete
the]{.smallcaps}** **[[transfer of agreement]{.underline}]{.smallcaps}**
**[(particularly, any increase to the permitted 'total area to be
disturbed').]{.smallcaps}**

**[transfer of agreement signature box for current
permittee]{.smallcaps}**

**[\_\_\_\_\_\_\_\_na\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for current permittee requested
date for transfer of permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of current permittee initials of current permittee
submittal date of this page]{.smallcaps}**

**[transfer of agreement signature box for new permittee]{.smallcaps}**

[[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}]{.smallcaps}
**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[print new permittee business name requested date for acceptance of
permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for new permittee print title of
individual signing for new permittee]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of new permittee initials of new permittee]{.smallcaps}**

**[by signing above as the new permittee, i agree to accept
responsibility, coverage, and liability for the existing]{.smallcaps}**

**[fugitive dust control permit
#\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and incorporated
fugitive dust control plan.]{.smallcaps}**

**[transfer of agreement signature box for project owner]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for project owner date
signed]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of project owner initials of project owner]{.smallcaps}**

**[by signing above as the project owner, i agree to the transfer of
responsibility of the existing fugitive dust control]{.smallcaps}**

**[permit #\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and
incorporated fugitive dust control plan to the above signed new
permittee.]{.smallcaps}**

**[[area below for department use]{.underline}]{.smallcaps}**

**[initial one of the conditions (a or b) given below]{.smallcaps}**

**A.) The department has determined that no change to the permit/plan
other than administrative change is necessary \_\_\_\_\_\_\_\_\_\_**

B.) The department has determined that necessary change(s) to the permit
and/or plan are required prior to transfer \_\_\_\_\_\_\_\_\_

+-------------------+---------+-------------------+---------+--------+
| **[permit         | **[     | **[transferred    | *       | **[e   |
| transfer of       | deemed] | perm              | *[issue | xpirat |
| agreement         | {.small | it]{.smallcaps}** | date]   | ion]{. |
| reviewed          | caps}** |                   | {.small | smallc |
| b                 |         | **[#\_\_          | caps}** | aps}** |
| y:]{.smallcaps}** | **[co   | \_\_\_\_\_\_\_\_\ |         |        |
|                   | mplete] | _\_\_\_\_\_\_\_\_ |         | **[d   |
|                   | {.small | issued            |         | ate]{. |
|                   | caps}** | b                 |         | smallc |
|                   |         | y:]{.smallcaps}** |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+

**[ATTACHMENT B]{.underline}**

CHECKLIST FOR STRUCTURE DEMOLITION

![](media/image2.png){width="0.8791338582677165in"
height="0.8019685039370079in"}**[[Albuquerque Environmental Health
Department - Air Quality Division
(Department)]{.underline}]{.smallcaps}**

**[[11850 Sunset Gardens SW - Albuquerque, New Mexico
87121]{.underline}]{.smallcaps}**

**[[(505) 768 - 1972 (Voice) (505) 768 - 2482 (TTY) (505) 768 - 1977
(Fax)]{.underline}]{.smallcaps}**

[Application for a Fugitive Dust Control Permit in Bernalillo
County]{.smallcaps}

[Albuquerque - Bernalillo County Air Quality Control Board Regulation
20.11.20 NMAC]{.smallcaps}

[Construction Permit for Surface Disturbance/Demolition]{.smallcaps}

**[[Division Receipt Stamp Below this line]{.underline}]{.smallcaps}**
[Effective Date Of This Form: 3/1/05]{.smallcaps}

> [submittal date/time]{.smallcaps}
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[received by]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[permit \#]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project Information
and General Activities (20.11.20.15 NMAC)]{.underline}]{.smallcaps}**
**([Print or Type]{.smallcaps})**

**1.** [Project Name]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** [Project Location]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[submit as an attachment to this application, an 8 ½" x 11" or larger
site map or plat of project location]{.smallcaps}**

**3.** [Project Street Address]{.smallcaps} (if available)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** [Major Cross Streets or Intersection Nearby]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** [Uniform Property Code]{.smallcaps}([s]{.smallcaps}) (if
available):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**6.** [Latitude/Longitude]{.smallcaps} (if available):
[North]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"
[West]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"

**7.** [Universal Transverse Mercator]{.smallcaps} (UTM Coordinates), if
available:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Northing]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Easting]{.smallcaps}

**8.** [Scope of Project (]{.smallcaps}check all that
apply[):]{.smallcaps} □[new building]{.smallcaps}(s)
[construction]{.smallcaps} □[subdivision development]{.smallcaps}
□[utility improvements]{.smallcaps}

**[X]{.mark}** [[structure demolition/renovation]{.smallcaps}]{.mark}
□[roadway development]{.smallcaps} □[other]{.smallcaps} (please
describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** [Active Operations (]{.smallcaps}check all that
apply[):]{.smallcaps} □[surface disturbance]{.smallcaps} [□bulk material
hauling or handling]{.smallcaps} [□unpaved roads]{.smallcaps}

[□paved roads]{.smallcaps} [□utility removal/installations]{.smallcaps}
[□structure demolition/renovation]{.smallcaps}
[□milling/grinding/cutting of surfaces]{.smallcaps}

[□other]{.smallcaps} (please describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** [Total Area To Be Disturbed]{.smallcaps} (acres or square
feet)\_\_\_\_\_\_\_\_\_acres;\_\_\_\_\_\_\_\_ft^2^, or, [for Demolition:
Total Cubic Feet]{.smallcaps} \_\_\_\_\_\_\_\_ft^3^

**NOTE: A Fugitive Dust Control Permit application is required for a
Building Demolition Project of** **[over 75,000 ft^3^]{.underline}**
**and must be received by the Department** **[10 business
days]{.underline}** **(Monday through Friday except holidays) before the
anticipated project start date. Asbestos Notification for
demolition/renovation of any commercial building, residential building
of 5 or more dwellings, or residential structure to be demolished to
build a non-residential structure must be received by the Department,
using a separate form,** **[10 working days]{.underline}** **(calendar
days) before the anticipated project start date. Building Demolitions in
Bernalillo County require Department signatures for dust control and
asbestos notification before a demolition permit will be issued by the
City or County.**

**11.** [A Fugitive Dust Control Permit application, for Total Area To
Be Disturbed of]{.smallcaps} [¾]{.smallcaps} [acre up to 25 acres, must
be received by the Air Quality Division]{.smallcaps} [[10 business
days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date. A Fugitive Dust Control Permit application, for Total Area To Be
Disturbed of more than 25 acres, must be received by the Air Quality
Division]{.smallcaps} [[20 business]{.underline}]{.smallcaps}

[[days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date.]{.smallcaps} **[Anticipated Project Start Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**12.** [An approved Fugitive Dust Control Permit shall be valid for 1
year from the date of approval by the Department or the Anticipated
Project Completion Date, whichever is longer, but no more than 5 years.
if the Scope of Project, Active Operations, Expiration Date, Total Area
To Be Disturbed, or Control Measure(s) change in any manner that are
determined by the Department to require additional conditions, then a
new Fugitive Dust Control Permit shall be required.]{.smallcaps} [[A
fugitive dust control permit may be renewed if the department receives a
written request from the permittee 10 business days
prior]{.underline}]{.smallcaps}

[[to expiration date.]{.underline}]{.smallcaps} **[Anticipated Project
Completion Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project
Information]{.underline}]{.smallcaps}** [[&]{.underline}]{.smallcaps}
**[[General Activities (20.11.20.15 nmac)
(continued)]{.underline}]{.smallcaps}**

**13.** ([check one box) active operations will be the total area to be
disturbed]{.smallcaps} □[,]{.smallcaps} [**[OR]{.underline}**, active
operations will be phased]{.smallcaps} □

**14.** [If phasing of active operations]{.smallcaps} (Explain Phasing
Plan and include Total Disturbed Area, in acres, at any given time)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**15.** [Is a site drainage plan required for this project]{.smallcaps}?
[yes]{.smallcaps}\_\_\_\_\_ [no]{.smallcaps}\_\_\_\_\_\_

**16.** [If yes to]{.smallcaps} **[#15]{.smallcaps}** [above, is
drainage plan approved and available upon request by the
department]{.smallcaps}? [yes]{.smallcaps}\_\_\_\_\_\_
[no]{.smallcaps}\_\_\_\_\_\_\_

**17.** [Expected volume of bulk material (on site fill, imported fill,
base coarse gravel, Etc.) to be handled during the duration]{.smallcaps}

[of this project]{.smallcaps} (in cubic yards)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**18.** [Volume of bulk material to be imported to this project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**19.** [Address of Location]{.smallcaps}([s]{.smallcaps}) [from which
bulk material will be imported to this project
site]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**20.** [Do the bernalillo cnty. locations, providing bulk material to
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**21.** [Volume of bulk material to be exported from project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**22.** [Address of location(s)]{.smallcaps} [in bernalillo cnty. that
will receive bulk material exported from this project
site\_\_]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**23.** [Do the bernalillo cnty. locations, receiving bulk material from
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23
nmac)]{.underline}]{.smallcaps}** **The "PERMITTEE" shall include in the
permit application one or more of the applicable reasonably available
control measures given in Part B.1 -- B.12 below,** **[OR]{.underline}**
**one or more other (alternative) fugitive dust control measures,
including measures taken to comply with any other statute or regulation
that would also effectively control fugitive dust during active and
inactive operations or construction activity** **(20.11.20.23 NMAC).**

**NOTE: If the "PERMITTEE" chooses to submit, as an attachment to this
application, an alternative fugitive dust control plan** **[in lieu of
the control measures given in Part B.1 -- B.12 below]{.underline}, the
alternative fugitive dust control plan (such as a storm water pollution
prevention plan) must include detailed information that addresses: 1)**
**the steady ongoing Reasonably Available Control Measures to mitigate
the release of Fugitive Dust from Active and Inactive Disturbed Surface
Areas; and 2) fugitive dust control Contingency Measures that will be
used; and 3) action(s) to be taken to mitigate property damage (see Part
C of this application). If submitting an alternative fugitive dust
control plan you still must complete and initial Parts** **[A, D, E, F,
G, H]{.smallcaps}, and** **[I]{.smallcaps}** **(if utilized) of this
application.**

**1.** **[Unpaved roadways]{.underline}** **\[check applicable
box(es)\]:**

a.□ paving using recycled asphalt, asphaltic concrete, concrete, or
petroleum products legal for such use;

> b.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}
>
> c\. **X** using wet suppression;
>
> d\. **X** using traffic controls, including decreased speed limits
> with appropriate enforcement; other traffic calming methods, vehicle
> access restrictions and controls; road closures or barricades; and
> off-road vehicle access controls and closures;
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** **[Paved roadways]{.underline}** **\[check applicable
box(es)\]:**

> a\. **X** cleaning up spillage and track out as necessary to prevent
> particulates from being pulverized and entrained into the atmosphere;
>
> b.□ using paved or gravel entry/exit aprons with devices, such as
> steel grates, capable of knocking mud and bulk material off vehicle
> tires;
>
> c.□ using on-site wheel washes;
>
> d.□ performing regularly scheduled vacuum street cleaning or wet
> sweeping with a sweeper certified by the manufacturer to be efficient
> at removing particulate matter having an aerodynamic diameter of less
> than 10 microns (i.e. PM~10~);
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**3.** **[Trucks hauling bulk materials on public and private
roadways]{.underline}** **\[check applicable box(es)\]:**

> a\. **X** using properly secured tarps or cargo covering that covers
> the entire surface area of the load;
>
> b.□ preventing leakage from the truck bed, sideboards, tailgate, or
> bottom dump gate;
>
> c.□ using wet suppression to increase moisture content of the bulk
> materials being hauled;
>
> d.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}
>
> e.□ maintaining a minimum of 6 inches of freeboard below the rim of
> the truck bed. Freeboard means the vertical distance from the highest
> portion of the load abutting the bed and the lowest part of the top
> rim of the truck bed abutting the load;
>
> f.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Short term** control measures shall include (check this box
> first if utilizing short term measures listed below):

a\. **X** wet suppression;

> b.□ dust suppressants applied in amounts, rates, and maintained as
> recommended by the manufacturer; [submit manufacturer's information as
> an attachment to this application]{.smallcaps}
>
> c.□ temporary upwind windbreaks, including fabric fences with the top
> at least 4 feet above grade, and with the bottom of the fence
>
> sufficiently anchored to the ground to prevent material from blowing
> underneath the fence; all windbreaks and fabric fences shall be
> maintained in an upright and functional condition at all times until
> no longer needed to prevent or abate fugitive dust; all accumulated
> material on the windward side of the windbreak shall be periodically
> removed to prevent failure of the windbreak;
>
> d.□ watering the site at the end of each workday sufficient to
> stabilize the work area;
>
> e.□ applying dust suppressants in amounts and rates recommended by the
> manufacturer on the worksite at the end of each work week if no active
> operations are going to take place over the weekend or if active
> operations stop for more than two consecutive days;
>
> f.□ starting construction at the location that is upwind from the
> prevailing wind direction and stabilizing disturbed areas before
> disturbing additional areas;
>
> g.□ clean up and removal of track-out material;
>
> h.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Long term** control measures shall include (check this box
> first if utilizing long term measures listed below):
>
> a.□ site stabilization using dust suppressants applied in amounts and
> rates recommended by the manufacturer and maintained as recommended by
> the manufacturer; [submit manufacturer's information as an attachment
> to this application]{.smallcaps}

b.□ reseeding using native grasses as specified in 20.11.20.24 NMAC --
[native grass seeding and mulch specifications]{.smallcaps};

c.□ xeriscaping;

> d.□ installing parallel rows of fabric fencing or other windbreaks set
> perpendicular to the prevailing wind direction either onsite or on a
> nearby property with the permission of the nearby property owner;

e.□ surfacing with gravel or other mulch material of a size and density
sufficient to prevent surface material from becoming airborne;

f.□ mulching and crimping of straw or hay as specified in Section
20.11.20.24 NMAC;

g.□ installing permanent perimeter and interior walls;

h.□ conventional landscaping techniques;

i\. **X** clean up and removal of track-out material;

j\. **X** other (alternative) \_\_**Restrict access to inactive areas to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**6.** **[Bulk material handling]{.underline}** **\[check applicable
box(es)\]:**

a.□ using spray bars;

b.□ applying wetting agents (surfactants) to bulk material;

c.□ using wet suppression through manual or mechanical application;

> d.□ adding dust suppressants to bulk materials in amounts and rates
> recommended by the manufacturer and maintained as recommended by the
> manufacturer; [submit manufacturer's information as an attachment to
> this application]{.smallcaps}

e.□ reducing process speeds;

f\. **X** reducing drop heights;

g.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**7.** **[Industrial sites]{.underline}** **\[check applicable
box(es)\]:** **NA**

a.□ paving roadways and parking area with recycled asphalt, asphaltic
concrete, concrete, or petroleum products legal for such use;

b.□ performing regularly scheduled vacuum street cleaning or wet
sweeping;

c.□ regularly using wet suppression on unpaved areas;

> d.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

e.□ installing wind breaks;

f.□ installing enclosures;

> g.□ installing on-site anemometers to measure wind speed; the
> anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify on-site personnel of high winds;

h.□ increasing wet suppression applications before and during high wind
conditions;

i.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**8.** **[Demolition/renovation activities ([NON-asbestos containing
materials present]{.smallcaps})]{.underline}** **\[check applicable
box(es)\]:**

a\. **X** using constant wet suppression on the debris piles during
demolition;

> b.□ using water or dust suppressants on the debris pile, applied in
> amounts and rates recommended by the manufacturer; [submit
> manufacturer's information as an attachment to this
> application]{.smallcaps}

c.□ using enclosures;

d.□ using curtains or shrouds;

e.□ using negative pressure dust collectors;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** **[Milling, grinding or cutting of paved or concrete
surfaces]{.underline}** **\[check applicable box(es)\]:** **NA**

a.□ constantly using wet suppression;

b.□ ongoing clean up of milled, ground or cut material by using wet
sweeping;

> c.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

d.□ using enclosures;

e.□ using curtains or shrouds;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** **[Pressure blasting operations]{.underline}** **\[check
applicable box(es)\]:** **NA**

a.□ using non-friable abrasive material;

b □ using curtains, enclosures or shrouds;

c.□ using negative pressure dust collectors;

d.□ using constant wet suppression;

e.□ maintaining ongoing clean up of abrasive material;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**11.** **[Spray painting and other coatings]{.underline}** **\[check
applicable box(es)\]:** **NA**

a.□ using enclosures that comply with applicable fire codes;

b.□ using curtains, enclosures or shrouds;

c.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**12.** **[High wind contingency measures]{.underline}** **\[check
applicable box(es)\]:**

**NOTE: It is required during a high wind event ([5 consecutive minutes
with an average wind speed of 30 miles per hour or higher]{.underline})
that** **[ALL]{.underline}** **fugitive dust sources cease all active
operations that are capable of producing fugitive dust; and continue to
use reasonably available control measures; and implement high wind
contingency measures.**

> a.□ installing and using on-site anemometers to measure wind speed;
> the anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify site personnel of high winds;

b\. **X** using constant wet suppression;

> c.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}

d.□ using wetting agents or surfactants on disturbed areas, bulk
materials or stockpiles;

e.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART C. -]{.underline}** **[[fugitive dust
control plan (plan) (20.11.20.14 nmac)]{.underline}]{.smallcaps}**
**[(Print or Type)]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The "PERMITTEE" is required to comply with a
Fugitive Dust Control Plan that** **[details]{.underline}** **the
Fugitive Dust Control Measures that will be used to mitigate the release
of Fugitive Dust from Active and Inactive Disturbed Surface Areas. This
includes: 1) steady ongoing Reasonably Available Control Measures; and
2) fugitive dust control Contingency Measures; and 3) action(s) that
will be taken to mitigate claims of property damage.** **[[If you are
not]{.underline}]{.smallcaps}** **[submitting as an attachment to this
application an alternative fugitive dust control plan, then you must
complete Part C.1 - C.3 below to complete your Fugitive Dust Control
Plan.]{.smallcaps}**

**1**. [Describe in detail the steady ongoing]{.smallcaps} [Reasonably
Available Control Measures that you may have selected in Part B.1 --
B.12 of this application that will be used during this project to
mitigate the release of Fugitive Dust from Active Disturbed Surface
Areas (]{.smallcaps}any [current]{.underline} operation capable of
creating dust[) and Inactive Disturbed Surface Areas
(]{.smallcaps}previously disturbed areas where active operations are
temporarily suspended[). (]{.smallcaps}Some examples are: Provide
detailed information that may include the type, size and quantity of
equipment that will be used for wet suppression, and frequency of use;
Type of traffic control that will be used; Type and locations of fencing
or walls that will be installed; Type and frequency of use of vacuum or
wet sweeping that will be used; Location and type of temporary pavements
that will be used; Seeding plan; etc.).

[Active]{.smallcaps} -\_\_**Water trucks will be used to provide wet
suppression or hose connected to fire hydrant when
available**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Limit traffic flow at inactive sites to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**2**. [Describe in detail the additional fugitive dust control
Contingency Measures that will be used during this project if the
Reasonably Available Control Measures chosen in Part]{.smallcaps} b.[1
-- B.12 and detailed in Part C.1 above are determined by the department
to be insufficient to provide adequate Fugitive Dust
Control]{.smallcaps} [during Active and Inactive
Operations.]{.smallcaps}

[Active]{.smallcaps} -\_\_\_**Reduce speed of heavy equipment hauling
operations; wet areas to be disturbed prior to
operations**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Restrict traffic on inactive
areas**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**3**. [Describe the action(s) that will be taken to mitigate claims of
property damage by fugitive dust generated at/from this
project]{.smallcaps}. **[It is required to remedy damage to real
properties caused by a violation of the permit (20.11.20.12.C
nmac).]{.smallcaps}**

\_\_\_**Will respond to reasonable claims of property damage. Will
provide for cleanup and/or repairs of affected
property**\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART - D. -]{.underline}** **[[high wind event
(20.11.20.16 nmac)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[NOTE]{.smallcaps}: A high wind event is a time period of 5
consecutive minutes with an average wind speed of 30 miles per hour or
higher.** **[ALL]{.underline}** **fugitive dust sources shall cease all
Active Operations that are capable of producing fugitive dust; and
continue to use Reasonably Available Control Measures; and implement
high wind contingency measures during a High Wind Event.**

**1**. [Describe in detail how the High Wind Contingency Measure(s)
chosen will be used during this project]{.smallcaps}\_\_\_**Cease
operations and maintain watering of site**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART -- E. -]{.underline}** **[[high wind
affirmative defense (20.11.20.16 nmac)]{.underline}]{.smallcaps}**

**[ATTENTION !!!]{.smallcaps}**

**[To assert a high wind affirmative defense,]{.smallcaps}** **[[the
permittee agrees to use one of the three]{.underline}]{.smallcaps}**
**[[Mandatory Control Measures shown below throughout the entire
duration of the permit]{.underline}, regardless of whether or not a high
wind event exists.]{.smallcaps}**

**[Do you wish to qualify for a High Wind Affirmative Defense during the
duration of this permit]{.smallcaps}?** **[yes]{.smallcaps}\_\_\_\_**
**[no]{.smallcaps}\_X\_\_**

**[If the answer to the above question is YES, then choose one of the
required Control Measures]{.smallcaps}** **[shown below]{.smallcaps}**

> 1[.]{.smallcaps}□ Using wet suppression sufficient to provide and
> maintain a soil moisture content of not less than 12 percent, and
> using properly maintained fabric fencing material around the perimeter
> of the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high); and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 2.□ Using chemical dust suppressants, in amounts and rates recommended
> by the manufacturer, sufficient to substantially reduce fugitive dust
> leaving the project area while Active Operations are idle, and using
> properly maintained fabric fencing material around the perimeter of
> the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high), and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 3.□ Using an alternative dust control measure or measures that provide
> fugitive dust control that is equal to or better than using the
> measures described in options E.1 or E.2 above; and during a High Wind
> Event ceasing all Active Operations but continuing to use all control
> measures. If you choose to qualify for a High Wind Affirmative Defense
> and are selecting E.3, submit as an attachment the alternative dust
> control measure or measures for Department approval.

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac)]{.underline}]{.smallcaps}** **[(Print or Type)]{.smallcaps}**

[At the time of submittal, any person filing an application for a
Fugitive Dust Control Permit shall pay the applicable fees required. No
application will be reviewed or permit issued unless all applicable fees
have been paid. Construction Permits for Surface Disturbance require a
Filing & Review Fee, and an Inspection Fee.]{.smallcaps}

**[1. FILING & REVIEW FEE TABLE]{.smallcaps}**

  -------------------------------- -------------------- --------------------
  **[Total project acreage to be   **[filing & review   **[Check Appropriate
  disturbed]{.smallcaps}**         Fee]{.smallcaps}**   Box]{.smallcaps}**

  **¾ acre to less than 2 acres**  **\$250.00**         

  **2 acres to less than 5 acres** **\$350.00**         

  **5 acres to less than 15        **\$450.00**         
  acres**                                               

  **15 acres or greater**          **\$550.00**         
  -------------------------------- -------------------- --------------------

**NOTE:** **[the permittee shall install and maintain a project sign,
issued or approved by the Department, for all fugitive dust control
projects of 10 or more acres.]{.smallcaps}**

**[Inspection Fee[:]{.smallcaps}]{.underline}** **[-]{.smallcaps}** **To
calculate the fugitive dust control Inspection Fee below, which is in
addition to the above Filing & Review Fee, multiply the total project
acreage to be disturbed by the per - acre rate shown in the table below.
The total project acreage to be disturbed, used to calculate the
Inspection Fee below, must be expressed as a whole number. When
rounding, if the number after the decimal point is less than 5, the
whole number remains unchanged. If the number after the decimal point is
5 or greater, the whole number shall be rounded up to the next whole
number. Rounding of acres shall occur before the Inspection Fee is
calculated.**

2\. INSPECTION FEE TABLE

+--------------------------+----+---------------+---+------------------+
| **[Total project acreage | *  | **[Per Acre   |   | **[Inspection    |
| to be                    | *[ | Rate]{        |   | Fe               |
| disturbed]{.smallcaps}** | Ti | .smallcaps}** |   | e]{.smallcaps}** |
|                          | me |               |   |                  |
| **[(rounded to nearest   | s] | **[(based on  |   |                  |
| whole                    | {. | 20.11.2.15    |   |                  |
| number)]{.smallcaps}**   | sm | nmac)]{       |   |                  |
|                          | al | .smallcaps}** |   |                  |
|                          | lc |               |   |                  |
|                          | ap |               |   |                  |
|                          | s} |               |   |                  |
|                          | ** |               |   |                  |
+--------------------------+----+---------------+---+------------------+
|                          | *  | **\$100.00**  | * | **\$**           |
|                          | *x |               | * |                  |
|                          | ** |               | = |                  |
|                          |    |               | * |                  |
|                          |    |               | * |                  |
+--------------------------+----+---------------+---+------------------+

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac) (continued)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[[Total Project Fee]{.underline}]{.smallcaps}** -- [Add the Filing &
Review Fee and the Inspection Fee from page 6 to determine the Total
Project Fee to be submitted with this application for a Fugitive Dust
Control Permit.]{.smallcaps}

3\. TOTAL PROJECT FEE TABLE

  ----------------------- ------------------------ ------------------------ ------- --------------------
  **[Filing & Review      **[Plus]{.smallcaps}**   **[Inspection                    **[Total Project Fee
  Fee]{.smallcaps}**                               Fee]{.smallcaps}**               Due]{.smallcaps}**

  \$                      **+**                    \$                       **=**   \$
  ----------------------- ------------------------ ------------------------ ------- --------------------

**NOTE: If an application to obtain a fugitive dust control permit is
submitted after active operations have commenced at the project
location, a late fee of 50 percent of the total project fee shall be
assessed in addition to the total project fee (20.11.2.17**
**[nmac).]{.smallcaps}** **In addition to this late fee for application
processing and permit issuance[,]{.smallcaps}** **civil penalty's may be
assessed** **pursuant to the New Mexico Air Quality Control Act, Chapter
74, Article 2 New Mexico Statutes Annotated 1978.**

**[Use the calculation below only if you are required to submit a late
fee.]{.smallcaps}**

**[Total Project Fee Due:]{.smallcaps}** **[\$]{.smallcaps}** **[X (1.5)
late fee factor =]{.smallcaps}** **[\$]{.smallcaps}** **[Total
Project/late Fee Due]{.smallcaps}**

**NOTE: Total Project Fee Due OR Total Project/Late Fee Due, required to
be paid at the time of application submittal, shall be paid by check or
money order payable to:** **[City of Albuquerque, Permits Program (Fund
242 -- Account \# 0421425)]{.underline}.** **Application and
accompanying fee may be delivered by mail to the address that appears at
the top of page 1 of this form or hand delivered to the same address
(between the hours of 8:00 am - 4:30 pm Mon. through Fri.). Call
768-1972 if hand delivering application and fee to insure that
appropriate staff is available to process a receipt.**

**[[PERMIT APPLICATION PART -- G. -- signature authority of permittee
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

**[NOTE:]{.smallcaps}** **This application shall include a fugitive dust
control plan that may utilize reasonably available control measures to
mitigate fugitive dust to meet the Objectives of Part 20.11.20 NMAC --
Fugitive Dust Control.** **By signing below, the applicant certifies
that the information provided in this application for a Fugitive Dust
Control permit is true, accurate and complete, and the applicant agrees
to be the "PERMITTEE". A "PERMITTEE" is a person, owner or operator and
all legal heirs, successors, and assigns who has applied for and
obtained a fugitive dust control permit approved by the Department. The
"PERMITTEE" agrees to take all actions required by the Fugitive Dust
Control permit issued by the Department to prevent a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping active
operations, if necessary.** **[The "PERMITTEE" is responsible for
complying with the fugitive dust control permit, the fugitive dust
control plan, and all requirements of Part 20.11.20 NMAC.- Fugitive Dust
Control. Failure to comply shall be a violation of Part 20.11.20 NMAC --
Fugitive Dust Control.]{.underline}**

[THE PERMITTEE SIGNATURE BOX MUST BE COMPLETED (**complete all
applicable information)**]{.smallcaps}

[\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print permittee's Business Name Email Address of Permittee Fax Number
of Permittee]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone Number of Permittee Cell Phone of Permittee Pager Number of
Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Permittee CITY State zip code]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Permittee]{.smallcaps} [Print
Title of Individual Signing for Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee]{.smallcaps} [Initials of Permittee]{.smallcaps}
[Date Submitted]{.smallcaps}

**[it is the responsibility of the permittee or designated responsible
person or official to ensure that the fugitive dust control permit or
amended permit contains current contact information and that
a]{.smallcaps}** **[[copy is maintained at the work site and is provided
to the department.]{.underline}]{.smallcaps}** **[failure to maintain
and provide up-to-date contact information shall be a violation of this
part. (20.11.20.18g nmac).]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The applicant signing above and applying to be
the "Permittee", may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined in 20.11.20.7CC
NMAC (definitions), if the person(s) agrees in writing to be a
responsible person. A Responsible Person can be the Permittee, the
Owner, the Operator, or another Person(s). Before Department review and
issuance of a fugitive dust control permit, if the Permittee wishes to
designate a person(s) as a responsible person(s) for complying with all
or specific elements of the fugitive dust control permit, the fugitive
dust control plan, and Part 20.11.20 NMAC.- Fugitive Dust Control, then
Section I - signature authority of "Responsible Person" may be used at
the time of application submittal and must include all applicable
information concerning the designated Responsible Person(s). After the
issuance of the permit, the Department may approve in writing a permit
amendment to add or change a designated responsible person(s).
(20.11.20.14B NMAC)**

**[[PERMIT APPLICATION PART -- H. -- Owner or Operator Information
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

Complete the owner and/or operator information below [ONLY IF DIFFERENT
THAN THE PERSON WHO HAS SIGNED AS THE PERMITTEE IN SECTION
G]{.underline}, OR as a responsible person(s) in Section I of this
application for a fugitive dust control permit.

**[NOTE:]{.smallcaps}** **If the Permittee fails to comply with the
provisions of 20.11.20 NMAC -- Fugitive Dust Control, the Owner or
Operator, if different from a Responsible Person or the Permittee, shall
be responsible for complying with the permit. If the Permittee fails to
take all required actions to prevent a violation of 20.11.20 NMAC --
Fugitive Dust Control, the Owner or Operator or designated Responsible
Person, if different than the Permittee, shall be responsible to take
all actions required to prevent or satisfactorily resolve a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping all active
operations, if necessary. To mitigate fugitive dust, all Inactive
Disturbed Surface Areas must be stabilized and maintained in stable
condition by the Owner, Operator, OR Person responsible for maintenance
of the disturbed surface. Failure to comply shall be a violation of
20.11.20 NMAC -- Fugitive Dust Control (20.11.20.12 NMAC).**

**[PROJECT O[WNER INFORMATION]{.smallcaps}]{.underline}** [(**complete
all applicable information)**]{.smallcaps}

[\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Owner's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Owner]{.smallcaps} [Print
Title of Individual Signing for Project Owner]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Owner]{.smallcaps} [Initials of Project
Owner]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Owner City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Owner Cell of Project Owner Pager of Project Owner Fax
of Owner]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Owner]{.smallcaps}

The **GENERAL PROVISIONS** of 20.11.20 NMAC -- Fugitive Dust Control
states that no person shall allow fugitive dust, track-out, or
transported material from any active operation, open storage pile, paved
or unpaved roadway or disturbed surface area, or inactive disturbed
surface area to be carried beyond the property line, right-of-way,
easement or any other area under the control of the person generating or
allowing the fugitive dust if the fugitive dust will: 1) adversely
affect the health, public welfare or safety of the residents of
Bernalillo county; or 2) impair visibility or the reasonable use of
property; or 3) be visible longer than a total of 15 minutes in any 1
hour observation period using the visible fugitive dust detection method
in 20.11.20.26 NMAC (visual determination of fugitive dust emissions
violations) or an equivalent method approved in writing by the
department.

**[project]{.underline}** **[[OPERATOR
INFORMATION]{.underline}]{.smallcaps}** [(**complete all applicable
information)**]{.smallcaps}

[\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Operator's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Operator]{.smallcaps}
[Print Title of Individual Signing for Project Operator]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Operator]{.smallcaps} [Initials of Project
Operator]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Operator City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Operator Cell of Project Operator Pager of Project
Operator Fax of Project Operator]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Operator]{.smallcaps}

**[[PERMIT APPLICATION PART -- I. -- signature authority of "Responsible
Person" (20.11.20.14 nmac)]{.underline}]{.smallcaps}** **[-
"]{.smallcaps}Responsible Person" means the person designated in a
permit who is responsible for complying with the permit, plan and
20.11.20 NMAC -- Fugitive Dust Control, to the extent specified in the
permit.**

**NOTE: If more than 1 individual will be designated a responsible
person at the time of this application submittal, make photocopies of
this page before completing any information. After the issuance of the
permit, the department may approve in writing an amendment to the permit
to add or change a designated responsible person(s).**

**The Permittee, may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined above. If
different then the Permittee, a person that agrees in writing to be a
responsible person will be liable for violations of the permit, plan and
Part 20.11.20 NMAC -- Fugitive Dust Control and shall be the first
person contacted by the Department to resolve a violation of the permit
or Part 20.11.20 NMAC to the extent outlined below in the 'Active
Operation responsibilities** **of individual signing as a Responsible
Person' \[activity(ies)\][.]{.smallcaps}**

[\_\_\_\_\_\_\_\_\_**na**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Responsible person's Business Name Print Name of individual
signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Title of individual signing as a Responsible Person Date
Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of individual signing as a Responsible Person]{.smallcaps}
[Initials of individual signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

[address of individual signing as a Responsible Person City State Zip
Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of individual signing as a Responsible Person Cell of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Pager of individual signing as a Responsible Person Fax of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email of individual signing as a Responsible Person Active Operation
responsibilies of individual signing as a Responsible
Person]{.smallcaps} **[\[activity(ies)\]]{.smallcaps}**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee approving the designation of above individual as
a responsible person Date Signed]{.smallcaps}

**[NOTE:]{.smallcaps}** **By signing above as a Responsible Person you
will be designated in the permit issued by the Department as responsible
for complying with the permit, plan and Part 20.11.20 NMAC -- Fugitive
Dust Control to the extent specified in the above \[activity(ies)\]. You
will be responsible for the above \[activity(ies)\] for the duration of
the permit OR until such time as the Department receives a request from
the permittee to remove you from being the responsible person for the
above \[activity(ies)\]. The Permittee will become the responsible
person for the \[activity(ies)\] that a responsible person is removed
from, unless a new responsible person is designated for the same
\[activity(ies)\] and approved by the Department in writing.**

**[NOTE:]{.smallcaps}** **The Permittee or responsible person shall**
**[[maintain a current copy of the permit at the work
site]{.underline}]{.smallcaps}** **and make the permit available and
explain the requirements of the permit to appropriate employees, agents,
contractors, and any other person performing work in the area of active
disturbance to assist in maintaining compliance with Part 20.11.20 NMAC
-- Fugitive Dust Control.**

**[Pursuant to the Air Quality Control Act, Chapter 74, Article 2 New
Mexico Statutes Annotated 1978, as amended; the Albuquerque Joint Air
Quality Control Board Ordinance, 9-5-1-1 ROA 1994; the Bernalillo County
Joint Air Quality Control Board Ordinance, Bernalillo County Ordinance
94-5, and the Albuquerque/Bernalillo County Air Quality Control Board
(A/BCAQCB) Regulation Title 20, Chapter 11, Part 20, New Mexico
Administrative Code (NMAC), (20.11.20 NMAC) - Fugitive Dust Control, and
upon authorized signatures below, this application together with
associated drawings, plans, appended documents, other data, and any
conditions attached to the permit by the Department, will become the
Fugitive Dust Control Permit. Table Below For Department
Use.]{.smallcaps}**

+-------------------+---------+-------------------+---------+--------+
| **[application    | **[     | **[permit issued  | *       | **[e   |
| reviewed          | deemed] | b                 | *[issue | xpirat |
| b                 | {.small | y:]{.smallcaps}** | date]   | ion]{. |
| y:]{.smallcaps}** | caps}** |                   | {.small | smallc |
|                   |         |                   | caps}** | aps}** |
|                   | **[co   |                   |         |        |
|                   | mplete] |                   |         | **[d   |
|                   | {.small |                   |         | ate]{. |
|                   | caps}** |                   |         | smallc |
|                   |         |                   |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+

**[[PERMIT APPLICATION PART -- J. -- transfer of fugitive dust control
permit and plan (20.11.20.14 nmac)]{.underline}]{.smallcaps}**

**[attention: use this signature page only if transferring complete
responsibility of a current fugitive dust control permit and plan to a
new permittee.]{.underline}**

**[a fugitive dust control permit and plan may be transferred to legal
heirs, successors, and assigns, who shall become the new permittee.
transfers may be made as an administrative amendment provided
that:]{.smallcaps}**

**[1) a written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[is drafted between the current
and new permittee, and the project owner; and]{.smallcaps}**

**[2) a specific date is established for the transfer of the permit and
plan responsibility, coverage, and liability; and]{.smallcaps}**

**[3) department approval of written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[has been
authorized.]{.smallcaps}**

**[there is no cost for transfer of the fugitive dust control permit and
plan if determined by the department that only administrative change is
needed. however, new application information must be submitted by the
new permittee or owner along with any applicable fees, if determined by
the department that necessary changes are required to complete
the]{.smallcaps}** **[[transfer of agreement]{.underline}]{.smallcaps}**
**[(particularly, any increase to the permitted 'total area to be
disturbed').]{.smallcaps}**

**[transfer of agreement signature box for current
permittee]{.smallcaps}**

**[\_\_\_\_\_\_\_na\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for current permittee requested
date for transfer of permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of current permittee initials of current permittee
submittal date of this page]{.smallcaps}**

**[transfer of agreement signature box for new permittee]{.smallcaps}**

[[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}]{.smallcaps}
**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[print new permittee business name requested date for acceptance of
permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for new permittee print title of
individual signing for new permittee]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of new permittee initials of new permittee]{.smallcaps}**

**[by signing above as the new permittee, i agree to accept
responsibility, coverage, and liability for the existing]{.smallcaps}**

**[fugitive dust control permit
#\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and incorporated
fugitive dust control plan.]{.smallcaps}**

**[transfer of agreement signature box for project owner]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for project owner date
signed]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of project owner initials of project owner]{.smallcaps}**

**[by signing above as the project owner, i agree to the transfer of
responsibility of the existing fugitive dust control]{.smallcaps}**

**[permit #\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and
incorporated fugitive dust control plan to the above signed new
permittee.]{.smallcaps}**

**[[area below for department use]{.underline}]{.smallcaps}**

**[initial one of the conditions (a or b) given below]{.smallcaps}**

**A.) The department has determined that no change to the permit/plan
other than administrative change is necessary \_\_\_\_\_\_\_\_\_\_**

B.) The department has determined that necessary change(s) to the permit
and/or plan are required prior to transfer \_\_\_\_\_\_\_\_\_

+-------------------+---------+-------------------+---------+--------+
| **[permit         | **[     | **[transferred    | *       | **[e   |
| transfer of       | deemed] | perm              | *[issue | xpirat |
| agreement         | {.small | it]{.smallcaps}** | date]   | ion]{. |
| reviewed          | caps}** |                   | {.small | smallc |
| b                 |         | **[#\_\_          | caps}** | aps}** |
| y:]{.smallcaps}** | **[co   | \_\_\_\_\_\_\_\_\ |         |        |
|                   | mplete] | _\_\_\_\_\_\_\_\_ |         | **[d   |
|                   | {.small | issued            |         | ate]{. |
|                   | caps}** | b                 |         | smallc |
|                   |         | y:]{.smallcaps}** |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+

**[ATTACHMENT C]{.underline}**

CHECKLIST FOR NEW CONSTRUCTION

![](media/image2.png){width="0.8791338582677165in"
height="0.8019685039370079in"}**[[Albuquerque Environmental Health
Department - Air Quality Division
(Department)]{.underline}]{.smallcaps}**

**[[11850 Sunset Gardens SW - Albuquerque, New Mexico
87121]{.underline}]{.smallcaps}**

**[[(505) 768 - 1972 (Voice) (505) 768 - 2482 (TTY) (505) 768 - 1977
(Fax)]{.underline}]{.smallcaps}**

[Application for a Fugitive Dust Control Permit in Bernalillo
County]{.smallcaps}

[Albuquerque - Bernalillo County Air Quality Control Board Regulation
20.11.20 NMAC]{.smallcaps}

[Construction Permit for Surface Disturbance/Demolition]{.smallcaps}

**[[Division Receipt Stamp Below this line]{.underline}]{.smallcaps}**
[Effective Date Of This Form: 3/1/05]{.smallcaps}

> [submittal date/time]{.smallcaps}
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[received by]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[permit \#]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project Information
and General Activities (20.11.20.15 NMAC)]{.underline}]{.smallcaps}**
**([Print or Type]{.smallcaps})**

**1.** [Project Name]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** [Project Location]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[submit as an attachment to this application, an 8 ½" x 11" or larger
site map or plat of project location]{.smallcaps}**

**3.** [Project Street Address]{.smallcaps} (if available)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** [Major Cross Streets or Intersection Nearby]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** [Uniform Property Code]{.smallcaps}([s]{.smallcaps}) (if
available):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**6.** [Latitude/Longitude]{.smallcaps} (if available):
[North]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"
[West]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"

**7.** [Universal Transverse Mercator]{.smallcaps} (UTM Coordinates), if
available:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Northing]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Easting]{.smallcaps}

**8.** [Scope of Project (]{.smallcaps}check all that
apply[):]{.smallcaps} **[X]{.mark}** [[new
building]{.smallcaps}(s)]{.mark} [[construction]{.smallcaps}]{.mark}
□[subdivision development]{.smallcaps} □[utility
improvements]{.smallcaps}

□[structure demolition/renovation]{.smallcaps} □[roadway
development]{.smallcaps} □[other]{.smallcaps} (please describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** [Active Operations (]{.smallcaps}check all that
apply[):]{.smallcaps} □[surface disturbance]{.smallcaps} [□bulk material
hauling or handling]{.smallcaps} [□unpaved roads]{.smallcaps}

[□paved roads]{.smallcaps} [□utility removal/installations]{.smallcaps}
[□structure demolition/renovation]{.smallcaps}
[□milling/grinding/cutting of surfaces]{.smallcaps}

[□other]{.smallcaps} (please describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** [Total Area To Be Disturbed]{.smallcaps} (acres or square
feet)\_\_\_\_\_\_\_\_\_acres;\_\_\_\_\_\_\_\_ft^2^, or, [for Demolition:
Total Cubic Feet]{.smallcaps} \_\_\_\_\_\_\_\_ft^3^

**NOTE: A Fugitive Dust Control Permit application is required for a
Building Demolition Project of** **[over 75,000 ft^3^]{.underline}**
**and must be received by the Department** **[10 business
days]{.underline}** **(Monday through Friday except holidays) before the
anticipated project start date. Asbestos Notification for
demolition/renovation of any commercial building, residential building
of 5 or more dwellings, or residential structure to be demolished to
build a non-residential structure must be received by the Department,
using a separate form,** **[10 working days]{.underline}** **(calendar
days) before the anticipated project start date. Building Demolitions in
Bernalillo County require Department signatures for dust control and
asbestos notification before a demolition permit will be issued by the
City or County.**

**11.** [A Fugitive Dust Control Permit application, for Total Area To
Be Disturbed of]{.smallcaps} [¾]{.smallcaps} [acre up to 25 acres, must
be received by the Air Quality Division]{.smallcaps} [[10 business
days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date. A Fugitive Dust Control Permit application, for Total Area To Be
Disturbed of more than 25 acres, must be received by the Air Quality
Division]{.smallcaps} [[20 business]{.underline}]{.smallcaps}

[[days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date.]{.smallcaps} **[Anticipated Project Start Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**12.** [An approved Fugitive Dust Control Permit shall be valid for 1
year from the date of approval by the Department or the Anticipated
Project Completion Date, whichever is longer, but no more than 5 years.
if the Scope of Project, Active Operations, Expiration Date, Total Area
To Be Disturbed, or Control Measure(s) change in any manner that are
determined by the Department to require additional conditions, then a
new Fugitive Dust Control Permit shall be required.]{.smallcaps} [[A
fugitive dust control permit may be renewed if the department receives a
written request from the permittee 10 business days
prior]{.underline}]{.smallcaps}

[[to expiration date.]{.underline}]{.smallcaps} **[Anticipated Project
Completion Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project
Information]{.underline}]{.smallcaps}** [[&]{.underline}]{.smallcaps}
**[[General Activities (20.11.20.15 nmac)
(continued)]{.underline}]{.smallcaps}**

**13.** ([check one box) active operations will be the total area to be
disturbed]{.smallcaps} □[,]{.smallcaps} [**[OR]{.underline}**, active
operations will be phased]{.smallcaps} □

**14.** [If phasing of active operations]{.smallcaps} (Explain Phasing
Plan and include Total Disturbed Area, in acres, at any given time)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**15.** [Is a site drainage plan required for this project]{.smallcaps}?
[yes]{.smallcaps}\_\_\_\_\_ [no]{.smallcaps}\_\_\_\_\_\_

**16.** [If yes to]{.smallcaps} **[#15]{.smallcaps}** [above, is
drainage plan approved and available upon request by the
department]{.smallcaps}? [yes]{.smallcaps}\_\_\_\_\_\_
[no]{.smallcaps}\_\_\_\_\_\_\_

**17.** [Expected volume of bulk material (on site fill, imported fill,
base coarse gravel, Etc.) to be handled during the duration]{.smallcaps}

[of this project]{.smallcaps} (in cubic yards)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**18.** [Volume of bulk material to be imported to this project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**19.** [Address of Location]{.smallcaps}([s]{.smallcaps}) [from which
bulk material will be imported to this project
site]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**20.** [Do the bernalillo cnty. locations, providing bulk material to
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**21.** [Volume of bulk material to be exported from project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**22.** [Address of location(s)]{.smallcaps} [in bernalillo cnty. that
will receive bulk material exported from this project
site\_\_]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**23.** [Do the bernalillo cnty. locations, receiving bulk material from
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23
nmac)]{.underline}]{.smallcaps}** **The "PERMITTEE" shall include in the
permit application one or more of the applicable reasonably available
control measures given in Part B.1 -- B.12 below,** **[OR]{.underline}**
**one or more other (alternative) fugitive dust control measures,
including measures taken to comply with any other statute or regulation
that would also effectively control fugitive dust during active and
inactive operations or construction activity** **(20.11.20.23 NMAC).**

**NOTE: If the "PERMITTEE" chooses to submit, as an attachment to this
application, an alternative fugitive dust control plan** **[in lieu of
the control measures given in Part B.1 -- B.12 below]{.underline}, the
alternative fugitive dust control plan (such as a storm water pollution
prevention plan) must include detailed information that addresses: 1)**
**the steady ongoing Reasonably Available Control Measures to mitigate
the release of Fugitive Dust from Active and Inactive Disturbed Surface
Areas; and 2) fugitive dust control Contingency Measures that will be
used; and 3) action(s) to be taken to mitigate property damage (see Part
C of this application). If submitting an alternative fugitive dust
control plan you still must complete and initial Parts** **[A, D, E, F,
G, H]{.smallcaps}, and** **[I]{.smallcaps}** **(if utilized) of this
application.**

**1.** **[Unpaved roadways]{.underline}** **\[check applicable
box(es)\]:**

a.□ paving using recycled asphalt, asphaltic concrete, concrete, or
petroleum products legal for such use;

> b.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}
>
> c\. **X** using wet suppression;
>
> d\. **X** using traffic controls, including decreased speed limits
> with appropriate enforcement; other traffic calming methods, vehicle
> access restrictions and controls; road closures or barricades; and
> off-road vehicle access controls and closures;
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** **[Paved roadways]{.underline}** **\[check applicable
box(es)\]:**

> a\. **X** cleaning up spillage and track out as necessary to prevent
> particulates from being pulverized and entrained into the atmosphere;
>
> b.□ using paved or gravel entry/exit aprons with devices, such as
> steel grates, capable of knocking mud and bulk material off vehicle
> tires;
>
> c.□ using on-site wheel washes;
>
> d.□ performing regularly scheduled vacuum street cleaning or wet
> sweeping with a sweeper certified by the manufacturer to be efficient
> at removing particulate matter having an aerodynamic diameter of less
> than 10 microns (i.e. PM~10~);
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**3.** **[Trucks hauling bulk materials on public and private
roadways]{.underline}** **\[check applicable box(es)\]:**

> a\. **X** using properly secured tarps or cargo covering that covers
> the entire surface area of the load;
>
> b.□ preventing leakage from the truck bed, sideboards, tailgate, or
> bottom dump gate;
>
> c.□ using wet suppression to increase moisture content of the bulk
> materials being hauled;
>
> d.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}
>
> e.□ maintaining a minimum of 6 inches of freeboard below the rim of
> the truck bed. Freeboard means the vertical distance from the highest
> portion of the load abutting the bed and the lowest part of the top
> rim of the truck bed abutting the load;
>
> f.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Short term** control measures shall include (check this box
> first if utilizing short term measures listed below):

a\. **X** wet suppression;

> b.□ dust suppressants applied in amounts, rates, and maintained as
> recommended by the manufacturer; [submit manufacturer's information as
> an attachment to this application]{.smallcaps}
>
> c.□ temporary upwind windbreaks, including fabric fences with the top
> at least 4 feet above grade, and with the bottom of the fence
>
> sufficiently anchored to the ground to prevent material from blowing
> underneath the fence; all windbreaks and fabric fences shall be
> maintained in an upright and functional condition at all times until
> no longer needed to prevent or abate fugitive dust; all accumulated
> material on the windward side of the windbreak shall be periodically
> removed to prevent failure of the windbreak;
>
> d.□ watering the site at the end of each workday sufficient to
> stabilize the work area;
>
> e.□ applying dust suppressants in amounts and rates recommended by the
> manufacturer on the worksite at the end of each work week if no active
> operations are going to take place over the weekend or if active
> operations stop for more than two consecutive days;
>
> f.□ starting construction at the location that is upwind from the
> prevailing wind direction and stabilizing disturbed areas before
> disturbing additional areas;
>
> g.□ clean up and removal of track-out material;
>
> h.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Long term** control measures shall include (check this box
> first if utilizing long term measures listed below):
>
> a.□ site stabilization using dust suppressants applied in amounts and
> rates recommended by the manufacturer and maintained as recommended by
> the manufacturer; [submit manufacturer's information as an attachment
> to this application]{.smallcaps}

b.□ reseeding using native grasses as specified in 20.11.20.24 NMAC --
[native grass seeding and mulch specifications]{.smallcaps};

c.□ xeriscaping;

> d.□ installing parallel rows of fabric fencing or other windbreaks set
> perpendicular to the prevailing wind direction either onsite or on a
> nearby property with the permission of the nearby property owner;

e.□ surfacing with gravel or other mulch material of a size and density
sufficient to prevent surface material from becoming airborne;

f.□ mulching and crimping of straw or hay as specified in Section
20.11.20.24 NMAC;

g.□ installing permanent perimeter and interior walls;

h.□ conventional landscaping techniques;

i\. **X** clean up and removal of track-out material;

j\. **X** other (alternative) \_\_**Restrict access to inactive areas to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**6.** **[Bulk material handling]{.underline}** **\[check applicable
box(es)\]:**

a.□ using spray bars;

b.□ applying wetting agents (surfactants) to bulk material;

c.□ using wet suppression through manual or mechanical application;

> d.□ adding dust suppressants to bulk materials in amounts and rates
> recommended by the manufacturer and maintained as recommended by the
> manufacturer; [submit manufacturer's information as an attachment to
> this application]{.smallcaps}

e.□ reducing process speeds;

f\. **X** reducing drop heights;

g.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**7.** **[Industrial sites]{.underline}** **\[check applicable
box(es)\]:** **NA**

a.□ paving roadways and parking area with recycled asphalt, asphaltic
concrete, concrete, or petroleum products legal for such use;

b.□ performing regularly scheduled vacuum street cleaning or wet
sweeping;

c.□ regularly using wet suppression on unpaved areas;

> d.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

e.□ installing wind breaks;

f.□ installing enclosures;

> g.□ installing on-site anemometers to measure wind speed; the
> anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify on-site personnel of high winds;

h.□ increasing wet suppression applications before and during high wind
conditions;

i.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**8.** **[Demolition/renovation activities ([NON-asbestos containing
materials present]{.smallcaps})]{.underline}** **\[check applicable
box(es)\]:** NA

a.□ using constant wet suppression on the debris piles during
demolition;

> b.□ using water or dust suppressants on the debris pile, applied in
> amounts and rates recommended by the manufacturer; [submit
> manufacturer's information as an attachment to this
> application]{.smallcaps}

c.□ using enclosures;

d.□ using curtains or shrouds;

e.□ using negative pressure dust collectors;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** **[Milling, grinding or cutting of paved or concrete
surfaces]{.underline}** **\[check applicable box(es)\]:**

a\. **X** constantly using wet suppression;

b.□ ongoing clean up of milled, ground or cut material by using wet
sweeping;

> c.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

d.□ using enclosures;

e.□ using curtains or shrouds;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** **[Pressure blasting operations]{.underline}** **\[check
applicable box(es)\]:**

a.□ using non-friable abrasive material;

b\. **X** using curtains, enclosures or shrouds;

c.□ using negative pressure dust collectors;

d.□ using constant wet suppression;

e.□ maintaining ongoing clean up of abrasive material;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**11.** **[Spray painting and other coatings]{.underline}** **\[check
applicable box(es)\]:**

a.□ using enclosures that comply with applicable fire codes;

b\. **X** using curtains, enclosures or shrouds;

c.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**12.** **[High wind contingency measures]{.underline}** **\[check
applicable box(es)\]:**

**NOTE: It is required during a high wind event ([5 consecutive minutes
with an average wind speed of 30 miles per hour or higher]{.underline})
that** **[ALL]{.underline}** **fugitive dust sources cease all active
operations that are capable of producing fugitive dust; and continue to
use reasonably available control measures; and implement high wind
contingency measures.**

> a.□ installing and using on-site anemometers to measure wind speed;
> the anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify site personnel of high winds;

b\. **X** using constant wet suppression;

> c.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}

d.□ using wetting agents or surfactants on disturbed areas, bulk
materials or stockpiles;

e.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART C. -]{.underline}** **[[fugitive dust
control plan (plan) (20.11.20.14 nmac)]{.underline}]{.smallcaps}**
**[(Print or Type)]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The "PERMITTEE" is required to comply with a
Fugitive Dust Control Plan that** **[details]{.underline}** **the
Fugitive Dust Control Measures that will be used to mitigate the release
of Fugitive Dust from Active and Inactive Disturbed Surface Areas. This
includes: 1) steady ongoing Reasonably Available Control Measures; and
2) fugitive dust control Contingency Measures; and 3) action(s) that
will be taken to mitigate claims of property damage.** **[[If you are
not]{.underline}]{.smallcaps}** **[submitting as an attachment to this
application an alternative fugitive dust control plan, then you must
complete Part C.1 - C.3 below to complete your Fugitive Dust Control
Plan.]{.smallcaps}**

**1**. [Describe in detail the steady ongoing]{.smallcaps} [Reasonably
Available Control Measures that you may have selected in Part B.1 --
B.12 of this application that will be used during this project to
mitigate the release of Fugitive Dust from Active Disturbed Surface
Areas (]{.smallcaps}any [current]{.underline} operation capable of
creating dust[) and Inactive Disturbed Surface Areas
(]{.smallcaps}previously disturbed areas where active operations are
temporarily suspended[). (]{.smallcaps}Some examples are: Provide
detailed information that may include the type, size and quantity of
equipment that will be used for wet suppression, and frequency of use;
Type of traffic control that will be used; Type and locations of fencing
or walls that will be installed; Type and frequency of use of vacuum or
wet sweeping that will be used; Location and type of temporary pavements
that will be used; Seeding plan; etc.).

[Active]{.smallcaps} -\_\_**Water trucks will be used to provide set
suppression or hose connected to fire hydrant when
available**\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Limit traffic flow at inactive sites to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**2**. [Describe in detail the additional fugitive dust control
Contingency Measures that will be used during this project if the
Reasonably Available Control Measures chosen in Part]{.smallcaps} b.[1
-- B.12 and detailed in Part C.1 above are determined by the department
to be insufficient to provide adequate Fugitive Dust
Control]{.smallcaps} [during Active and Inactive
Operations.]{.smallcaps}

[Active]{.smallcaps} -\_\_\_**Reduce speed of heavy equipment hauling
operations; wet areas to be disturbed prior to
operations**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Restrict traffic on inactive
areas**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**3**. [Describe the action(s) that will be taken to mitigate claims of
property damage by fugitive dust generated at/from this
project]{.smallcaps}. **[It is required to remedy damage to real
properties caused by a violation of the permit (20.11.20.12.C
nmac).]{.smallcaps}**

\_\_\_**Will respond to reasonable claims of property damage. Will
provide for cleanup and/or repairs of affected
property**\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART - D. -]{.underline}** **[[high wind event
(20.11.20.16 nmac)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[NOTE]{.smallcaps}: A high wind event is a time period of 5
consecutive minutes with an average wind speed of 30 miles per hour or
higher.** **[ALL]{.underline}** **fugitive dust sources shall cease all
Active Operations that are capable of producing fugitive dust; and
continue to use Reasonably Available Control Measures; and implement
high wind contingency measures during a High Wind Event.**

**1**. [Describe in detail how the High Wind Contingency Measure(s)
chosen will be used during this project]{.smallcaps}\_\_\_**Cease
operations and maintain watering of site**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART -- E. -]{.underline}** **[[high wind
affirmative defense (20.11.20.16 nmac)]{.underline}]{.smallcaps}**

**[ATTENTION !!!]{.smallcaps}**

**[To assert a high wind affirmative defense,]{.smallcaps}** **[[the
permittee agrees to use one of the three]{.underline}]{.smallcaps}**
**[[Mandatory Control Measures shown below throughout the entire
duration of the permit]{.underline}, regardless of whether or not a high
wind event exists.]{.smallcaps}**

**[Do you wish to qualify for a High Wind Affirmative Defense during the
duration of this permit]{.smallcaps}?** **[yes]{.smallcaps}\_\_\_\_**
**[no]{.smallcaps}\_X\_\_**

**[If the answer to the above question is YES, then choose one of the
required Control Measures]{.smallcaps}** **[shown below]{.smallcaps}**

> 1[.]{.smallcaps}□ Using wet suppression sufficient to provide and
> maintain a soil moisture content of not less than 12 percent, and
> using properly maintained fabric fencing material around the perimeter
> of the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high); and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 2.□ Using chemical dust suppressants, in amounts and rates recommended
> by the manufacturer, sufficient to substantially reduce fugitive dust
> leaving the project area while Active Operations are idle, and using
> properly maintained fabric fencing material around the perimeter of
> the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high), and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 3.□ Using an alternative dust control measure or measures that provide
> fugitive dust control that is equal to or better than using the
> measures described in options E.1 or E.2 above; and during a High Wind
> Event ceasing all Active Operations but continuing to use all control
> measures. If you choose to qualify for a High Wind Affirmative Defense
> and are selecting E.3, submit as an attachment the alternative dust
> control measure or measures for Department approval.

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac)]{.underline}]{.smallcaps}** **[(Print or Type)]{.smallcaps}**

[At the time of submittal, any person filing an application for a
Fugitive Dust Control Permit shall pay the applicable fees required. No
application will be reviewed or permit issued unless all applicable fees
have been paid. Construction Permits for Surface Disturbance require a
Filing & Review Fee, and an Inspection Fee.]{.smallcaps}

**[1. FILING & REVIEW FEE TABLE]{.smallcaps}**

  -------------------------------- -------------------- --------------------
  **[Total project acreage to be   **[filing & review   **[Check Appropriate
  disturbed]{.smallcaps}**         Fee]{.smallcaps}**   Box]{.smallcaps}**

  **¾ acre to less than 2 acres**  **\$250.00**         

  **2 acres to less than 5 acres** **\$350.00**         

  **5 acres to less than 15        **\$450.00**         
  acres**                                               

  **15 acres or greater**          **\$550.00**         
  -------------------------------- -------------------- --------------------

**NOTE:** **[the permittee shall install and maintain a project sign,
issued or approved by the Department, for all fugitive dust control
projects of 10 or more acres.]{.smallcaps}**

**[Inspection Fee[:]{.smallcaps}]{.underline}** **[-]{.smallcaps}** **To
calculate the fugitive dust control Inspection Fee below, which is in
addition to the above Filing & Review Fee, multiply the total project
acreage to be disturbed by the per - acre rate shown in the table below.
The total project acreage to be disturbed, used to calculate the
Inspection Fee below, must be expressed as a whole number. When
rounding, if the number after the decimal point is less than 5, the
whole number remains unchanged. If the number after the decimal point is
5 or greater, the whole number shall be rounded up to the next whole
number. Rounding of acres shall occur before the Inspection Fee is
calculated.**

2\. INSPECTION FEE TABLE

+--------------------------+----+---------------+---+------------------+
| **[Total project acreage | *  | **[Per Acre   |   | **[Inspection    |
| to be                    | *[ | Rate]{        |   | Fe               |
| disturbed]{.smallcaps}** | Ti | .smallcaps}** |   | e]{.smallcaps}** |
|                          | me |               |   |                  |
| **[(rounded to nearest   | s] | **[(based on  |   |                  |
| whole                    | {. | 20.11.2.15    |   |                  |
| number)]{.smallcaps}**   | sm | nmac)]{       |   |                  |
|                          | al | .smallcaps}** |   |                  |
|                          | lc |               |   |                  |
|                          | ap |               |   |                  |
|                          | s} |               |   |                  |
|                          | ** |               |   |                  |
+--------------------------+----+---------------+---+------------------+
|                          | *  | **\$100.00**  | * | **\$**           |
|                          | *x |               | * |                  |
|                          | ** |               | = |                  |
|                          |    |               | * |                  |
|                          |    |               | * |                  |
+--------------------------+----+---------------+---+------------------+

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac) (continued)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[[Total Project Fee]{.underline}]{.smallcaps}** -- [Add the Filing &
Review Fee and the Inspection Fee from page 6 to determine the Total
Project Fee to be submitted with this application for a Fugitive Dust
Control Permit.]{.smallcaps}

3\. TOTAL PROJECT FEE TABLE

  ----------------------- ------------------------ ------------------------ ------- --------------------
  **[Filing & Review      **[Plus]{.smallcaps}**   **[Inspection                    **[Total Project Fee
  Fee]{.smallcaps}**                               Fee]{.smallcaps}**               Due]{.smallcaps}**

  \$                      **+**                    \$                       **=**   \$
  ----------------------- ------------------------ ------------------------ ------- --------------------

**NOTE: If an application to obtain a fugitive dust control permit is
submitted after active operations have commenced at the project
location, a late fee of 50 percent of the total project fee shall be
assessed in addition to the total project fee (20.11.2.17**
**[nmac).]{.smallcaps}** **In addition to this late fee for application
processing and permit issuance[,]{.smallcaps}** **civil penalty's may be
assessed** **pursuant to the New Mexico Air Quality Control Act, Chapter
74, Article 2 New Mexico Statutes Annotated 1978.**

**[Use the calculation below only if you are required to submit a late
fee.]{.smallcaps}**

**[Total Project Fee Due:]{.smallcaps}** **[\$]{.smallcaps}** **[X (1.5)
late fee factor =]{.smallcaps}** **[\$]{.smallcaps}** **[Total
Project/late Fee Due]{.smallcaps}**

**NOTE: Total Project Fee Due OR Total Project/Late Fee Due, required to
be paid at the time of application submittal, shall be paid by check or
money order payable to:** **[City of Albuquerque, Permits Program (Fund
242 -- Account \# 0421425)]{.underline}.** **Application and
accompanying fee may be delivered by mail to the address that appears at
the top of page 1 of this form or hand delivered to the same address
(between the hours of 8:00 am - 4:30 pm Mon. through Fri.). Call
768-1972 if hand delivering application and fee to insure that
appropriate staff is available to process a receipt.**

**[[PERMIT APPLICATION PART -- G. -- signature authority of permittee
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

**[NOTE:]{.smallcaps}** **This application shall include a fugitive dust
control plan that may utilize reasonably available control measures to
mitigate fugitive dust to meet the Objectives of Part 20.11.20 NMAC --
Fugitive Dust Control.** **By signing below, the applicant certifies
that the information provided in this application for a Fugitive Dust
Control permit is true, accurate and complete, and the applicant agrees
to be the "PERMITTEE". A "PERMITTEE" is a person, owner or operator and
all legal heirs, successors, and assigns who has applied for and
obtained a fugitive dust control permit approved by the Department. The
"PERMITTEE" agrees to take all actions required by the Fugitive Dust
Control permit issued by the Department to prevent a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping active
operations, if necessary.** **[The "PERMITTEE" is responsible for
complying with the fugitive dust control permit, the fugitive dust
control plan, and all requirements of Part 20.11.20 NMAC.- Fugitive Dust
Control. Failure to comply shall be a violation of Part 20.11.20 NMAC --
Fugitive Dust Control.]{.underline}**

[THE PERMITTEE SIGNATURE BOX MUST BE COMPLETED (**complete all
applicable information)**]{.smallcaps}

[\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print permittee's Business Name Email Address of Permittee Fax Number
of Permittee]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone Number of Permittee Cell Phone of Permittee Pager Number of
Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Permittee CITY State zip code]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Permittee]{.smallcaps} [Print
Title of Individual Signing for Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee]{.smallcaps} [Initials of Permittee]{.smallcaps}
[Date Submitted]{.smallcaps}

**[it is the responsibility of the permittee or designated responsible
person or official to ensure that the fugitive dust control permit or
amended permit contains current contact information and that
a]{.smallcaps}** **[[copy is maintained at the work site and is provided
to the department.]{.underline}]{.smallcaps}** **[failure to maintain
and provide up-to-date contact information shall be a violation of this
part. (20.11.20.18g nmac).]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The applicant signing above and applying to be
the "Permittee", may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined in 20.11.20.7CC
NMAC (definitions), if the person(s) agrees in writing to be a
responsible person. A Responsible Person can be the Permittee, the
Owner, the Operator, or another Person(s). Before Department review and
issuance of a fugitive dust control permit, if the Permittee wishes to
designate a person(s) as a responsible person(s) for complying with all
or specific elements of the fugitive dust control permit, the fugitive
dust control plan, and Part 20.11.20 NMAC.- Fugitive Dust Control, then
Section I - signature authority of "Responsible Person" may be used at
the time of application submittal and must include all applicable
information concerning the designated Responsible Person(s). After the
issuance of the permit, the Department may approve in writing a permit
amendment to add or change a designated responsible person(s).
(20.11.20.14B NMAC)**

**[[PERMIT APPLICATION PART -- H. -- Owner or Operator Information
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

Complete the owner and/or operator information below [ONLY IF DIFFERENT
THAN THE PERSON WHO HAS SIGNED AS THE PERMITTEE IN SECTION
G]{.underline}, OR as a responsible person(s) in Section I of this
application for a fugitive dust control permit.

**[NOTE:]{.smallcaps}** **If the Permittee fails to comply with the
provisions of 20.11.20 NMAC -- Fugitive Dust Control, the Owner or
Operator, if different from a Responsible Person or the Permittee, shall
be responsible for complying with the permit. If the Permittee fails to
take all required actions to prevent a violation of 20.11.20 NMAC --
Fugitive Dust Control, the Owner or Operator or designated Responsible
Person, if different than the Permittee, shall be responsible to take
all actions required to prevent or satisfactorily resolve a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping all active
operations, if necessary. To mitigate fugitive dust, all Inactive
Disturbed Surface Areas must be stabilized and maintained in stable
condition by the Owner, Operator, OR Person responsible for maintenance
of the disturbed surface. Failure to comply shall be a violation of
20.11.20 NMAC -- Fugitive Dust Control (20.11.20.12 NMAC).**

**[PROJECT O[WNER INFORMATION]{.smallcaps}]{.underline}** [(**complete
all applicable information)**]{.smallcaps}

[\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Owner's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Owner]{.smallcaps} [Print
Title of Individual Signing for Project Owner]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Owner]{.smallcaps} [Initials of Project
Owner]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Owner City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Owner Cell of Project Owner Pager of Project Owner Fax
of Owner]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Owner]{.smallcaps}

The **GENERAL PROVISIONS** of 20.11.20 NMAC -- Fugitive Dust Control
states that no person shall allow fugitive dust, track-out, or
transported material from any active operation, open storage pile, paved
or unpaved roadway or disturbed surface area, or inactive disturbed
surface area to be carried beyond the property line, right-of-way,
easement or any other area under the control of the person generating or
allowing the fugitive dust if the fugitive dust will: 1) adversely
affect the health, public welfare or safety of the residents of
Bernalillo county; or 2) impair visibility or the reasonable use of
property; or 3) be visible longer than a total of 15 minutes in any 1
hour observation period using the visible fugitive dust detection method
in 20.11.20.26 NMAC (visual determination of fugitive dust emissions
violations) or an equivalent method approved in writing by the
department.

**[project]{.underline}** **[[OPERATOR
INFORMATION]{.underline}]{.smallcaps}** [(**complete all applicable
information)**]{.smallcaps}

[\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Operator's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Operator]{.smallcaps}
[Print Title of Individual Signing for Project Operator]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Operator]{.smallcaps} [Initials of Project
Operator]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Operator City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Operator Cell of Project Operator Pager of Project
Operator Fax of Project Operator]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Operator]{.smallcaps}

**[[PERMIT APPLICATION PART -- I. -- signature authority of "Responsible
Person" (20.11.20.14 nmac)]{.underline}]{.smallcaps}** **[-
"]{.smallcaps}Responsible Person" means the person designated in a
permit who is responsible for complying with the permit, plan and
20.11.20 NMAC -- Fugitive Dust Control, to the extent specified in the
permit.**

**NOTE: If more than 1 individual will be designated a responsible
person at the time of this application submittal, make photocopies of
this page before completing any information. After the issuance of the
permit, the department may approve in writing an amendment to the permit
to add or change a designated responsible person(s).**

**The Permittee, may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined above. If
different then the Permittee, a person that agrees in writing to be a
responsible person will be liable for violations of the permit, plan and
Part 20.11.20 NMAC -- Fugitive Dust Control and shall be the first
person contacted by the Department to resolve a violation of the permit
or Part 20.11.20 NMAC to the extent outlined below in the 'Active
Operation responsibilities** **of individual signing as a Responsible
Person' \[activity(ies)\][.]{.smallcaps}**

[\_\_\_\_\_\_**na**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Responsible person's Business Name Print Name of individual
signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Title of individual signing as a Responsible Person Date
Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of individual signing as a Responsible Person]{.smallcaps}
[Initials of individual signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

[address of individual signing as a Responsible Person City State Zip
Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of individual signing as a Responsible Person Cell of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Pager of individual signing as a Responsible Person Fax of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email of individual signing as a Responsible Person Active Operation
responsibilies of individual signing as a Responsible
Person]{.smallcaps} **[\[activity(ies)\]]{.smallcaps}**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee approving the designation of above individual as
a responsible person Date Signed]{.smallcaps}

**[NOTE:]{.smallcaps}** **By signing above as a Responsible Person you
will be designated in the permit issued by the Department as responsible
for complying with the permit, plan and Part 20.11.20 NMAC -- Fugitive
Dust Control to the extent specified in the above \[activity(ies)\]. You
will be responsible for the above \[activity(ies)\] for the duration of
the permit OR until such time as the Department receives a request from
the permittee to remove you from being the responsible person for the
above \[activity(ies)\]. The Permittee will become the responsible
person for the \[activity(ies)\] that a responsible person is removed
from, unless a new responsible person is designated for the same
\[activity(ies)\] and approved by the Department in writing.**

**[NOTE:]{.smallcaps}** **The Permittee or responsible person shall**
**[[maintain a current copy of the permit at the work
site]{.underline}]{.smallcaps}** **and make the permit available and
explain the requirements of the permit to appropriate employees, agents,
contractors, and any other person performing work in the area of active
disturbance to assist in maintaining compliance with Part 20.11.20 NMAC
-- Fugitive Dust Control.**

**[Pursuant to the Air Quality Control Act, Chapter 74, Article 2 New
Mexico Statutes Annotated 1978, as amended; the Albuquerque Joint Air
Quality Control Board Ordinance, 9-5-1-1 ROA 1994; the Bernalillo County
Joint Air Quality Control Board Ordinance, Bernalillo County Ordinance
94-5, and the Albuquerque/Bernalillo County Air Quality Control Board
(A/BCAQCB) Regulation Title 20, Chapter 11, Part 20, New Mexico
Administrative Code (NMAC), (20.11.20 NMAC) - Fugitive Dust Control, and
upon authorized signatures below, this application together with
associated drawings, plans, appended documents, other data, and any
conditions attached to the permit by the Department, will become the
Fugitive Dust Control Permit. Table Below For Department
Use.]{.smallcaps}**

+-------------------+---------+-------------------+---------+--------+
| **[application    | **[     | **[permit issued  | *       | **[e   |
| reviewed          | deemed] | b                 | *[issue | xpirat |
| b                 | {.small | y:]{.smallcaps}** | date]   | ion]{. |
| y:]{.smallcaps}** | caps}** |                   | {.small | smallc |
|                   |         |                   | caps}** | aps}** |
|                   | **[co   |                   |         |        |
|                   | mplete] |                   |         | **[d   |
|                   | {.small |                   |         | ate]{. |
|                   | caps}** |                   |         | smallc |
|                   |         |                   |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+

**[[PERMIT APPLICATION PART -- J. -- transfer of fugitive dust control
permit and plan (20.11.20.14 nmac)]{.underline}]{.smallcaps}**

**[attention: use this signature page only if transferring complete
responsibility of a current fugitive dust control permit and plan to a
new permittee.]{.underline}**

**[a fugitive dust control permit and plan may be transferred to legal
heirs, successors, and assigns, who shall become the new permittee.
transfers may be made as an administrative amendment provided
that:]{.smallcaps}**

**[1) a written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[is drafted between the current
and new permittee, and the project owner; and]{.smallcaps}**

**[2) a specific date is established for the transfer of the permit and
plan responsibility, coverage, and liability; and]{.smallcaps}**

**[3) department approval of written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[has been
authorized.]{.smallcaps}**

**[there is no cost for transfer of the fugitive dust control permit and
plan if determined by the department that only administrative change is
needed. however, new application information must be submitted by the
new permittee or owner along with any applicable fees, if determined by
the department that necessary changes are required to complete
the]{.smallcaps}** **[[transfer of agreement]{.underline}]{.smallcaps}**
**[(particularly, any increase to the permitted 'total area to be
disturbed').]{.smallcaps}**

**[transfer of agreement signature box for current
permittee]{.smallcaps}**

**[\_\_\_\_\_\_na\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for current permittee requested
date for transfer of permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of current permittee initials of current permittee
submittal date of this page]{.smallcaps}**

**[transfer of agreement signature box for new permittee]{.smallcaps}**

[[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}]{.smallcaps}
**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[print new permittee business name requested date for acceptance of
permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for new permittee print title of
individual signing for new permittee]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of new permittee initials of new permittee]{.smallcaps}**

**[by signing above as the new permittee, i agree to accept
responsibility, coverage, and liability for the existing]{.smallcaps}**

**[fugitive dust control permit
#\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and incorporated
fugitive dust control plan.]{.smallcaps}**

**[transfer of agreement signature box for project owner]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for project owner date
signed]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of project owner initials of project owner]{.smallcaps}**

**[by signing above as the project owner, i agree to the transfer of
responsibility of the existing fugitive dust control]{.smallcaps}**

**[permit #\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and
incorporated fugitive dust control plan to the above signed new
permittee.]{.smallcaps}**

**[[area below for department use]{.underline}]{.smallcaps}**

**[initial one of the conditions (a or b) given below]{.smallcaps}**

**A.) The department has determined that no change to the permit/plan
other than administrative change is necessary \_\_\_\_\_\_\_\_\_\_**

B.) The department has determined that necessary change(s) to the permit
and/or plan are required prior to transfer \_\_\_\_\_\_\_\_\_

+-------------------+---------+-------------------+---------+--------+
| **[permit         | **[     | **[transferred    | *       | **[e   |
| transfer of       | deemed] | perm              | *[issue | xpirat |
| agreement         | {.small | it]{.smallcaps}** | date]   | ion]{. |
| reviewed          | caps}** |                   | {.small | smallc |
| b                 |         | **[#\_\_          | caps}** | aps}** |
| y:]{.smallcaps}** | **[co   | \_\_\_\_\_\_\_\_\ |         |        |
|                   | mplete] | _\_\_\_\_\_\_\_\_ |         | **[d   |
|                   | {.small | issued            |         | ate]{. |
|                   | caps}** | b                 |         | smallc |
|                   |         | y:]{.smallcaps}** |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+

**[ATTACHMENT D]{.underline}**

CHECKLIST FOR UTILITY IMPROVEMENT

![](media/image2.png){width="0.8791338582677165in"
height="0.8019685039370079in"}**[[Albuquerque Environmental Health
Department - Air Quality Division
(Department)]{.underline}]{.smallcaps}**

**[[11850 Sunset Gardens SW - Albuquerque, New Mexico
87121]{.underline}]{.smallcaps}**

**[[(505) 768 - 1972 (Voice) (505) 768 - 2482 (TTY) (505) 768 - 1977
(Fax)]{.underline}]{.smallcaps}**

[Application for a Fugitive Dust Control Permit in Bernalillo
County]{.smallcaps}

[Albuquerque - Bernalillo County Air Quality Control Board Regulation
20.11.20 NMAC]{.smallcaps}

[Construction Permit for Surface Disturbance/Demolition]{.smallcaps}

**[[Division Receipt Stamp Below this line]{.underline}]{.smallcaps}**
[Effective Date Of This Form: 3/1/05]{.smallcaps}

> [submittal date/time]{.smallcaps}
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[received by]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[permit \#]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project Information
and General Activities (20.11.20.15 NMAC)]{.underline}]{.smallcaps}**
**([Print or Type]{.smallcaps})**

**1.** [Project Name]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** [Project Location]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[submit as an attachment to this application, an 8 ½" x 11" or larger
site map or plat of project location]{.smallcaps}**

**3.** [Project Street Address]{.smallcaps} (if available)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** [Major Cross Streets or Intersection Nearby]{.smallcaps}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** [Uniform Property Code]{.smallcaps}([s]{.smallcaps}) (if
available):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**6.** [Latitude/Longitude]{.smallcaps} (if available):
[North]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"
[West]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_^0^\_\_\_\_\_\_\_\_\_\_\_'\_\_\_\_\_\_\_\_\_\_\_"

**7.** [Universal Transverse Mercator]{.smallcaps} (UTM Coordinates), if
available:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Northing]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[Easting]{.smallcaps}

**8.** [Scope of Project (]{.smallcaps}check all that
apply[):]{.smallcaps} □[new building]{.smallcaps}(s)
[construction]{.smallcaps} □[subdivision development]{.smallcaps}
**[X]{.mark}** **[[utility improvements]{.smallcaps}]{.mark}**

□[structure demolition/renovation]{.smallcaps} □[roadway
development]{.smallcaps} □[other]{.smallcaps} (please describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** [Active Operations (]{.smallcaps}check all that
apply[):]{.smallcaps} □[surface disturbance]{.smallcaps} [□bulk material
hauling or handling]{.smallcaps} [□unpaved roads]{.smallcaps}

[□paved roads]{.smallcaps} [□utility removal/installations]{.smallcaps}
[□structure demolition/renovation]{.smallcaps}
[□milling/grinding/cutting of surfaces]{.smallcaps}

[□other]{.smallcaps} (please describe)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** [Total Area To Be Disturbed]{.smallcaps} (acres or square
feet)\_\_\_\_\_\_\_\_\_acres;\_\_\_\_\_\_\_\_ft^2^, or, [for Demolition:
Total Cubic Feet]{.smallcaps} \_\_\_\_\_\_\_\_ft^3^

**NOTE: A Fugitive Dust Control Permit application is required for a
Building Demolition Project of** **[over 75,000 ft^3^]{.underline}**
**and must be received by the Department** **[10 business
days]{.underline}** **(Monday through Friday except holidays) before the
anticipated project start date. Asbestos Notification for
demolition/renovation of any commercial building, residential building
of 5 or more dwellings, or residential structure to be demolished to
build a non-residential structure must be received by the Department,
using a separate form,** **[10 working days]{.underline}** **(calendar
days) before the anticipated project start date. Building Demolitions in
Bernalillo County require Department signatures for dust control and
asbestos notification before a demolition permit will be issued by the
City or County.**

**11.** [A Fugitive Dust Control Permit application, for Total Area To
Be Disturbed of]{.smallcaps} [¾]{.smallcaps} [acre up to 25 acres, must
be received by the Air Quality Division]{.smallcaps} [[10 business
days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date. A Fugitive Dust Control Permit application, for Total Area To Be
Disturbed of more than 25 acres, must be received by the Air Quality
Division]{.smallcaps} [[20 business]{.underline}]{.smallcaps}

[[days]{.underline}]{.smallcaps} [before the Anticipated Project Start
Date.]{.smallcaps} **[Anticipated Project Start Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**12.** [An approved Fugitive Dust Control Permit shall be valid for 1
year from the date of approval by the Department or the Anticipated
Project Completion Date, whichever is longer, but no more than 5 years.
if the Scope of Project, Active Operations, Expiration Date, Total Area
To Be Disturbed, or Control Measure(s) change in any manner that are
determined by the Department to require additional conditions, then a
new Fugitive Dust Control Permit shall be required.]{.smallcaps} [[A
fugitive dust control permit may be renewed if the department receives a
written request from the permittee 10 business days
prior]{.underline}]{.smallcaps}

[[to expiration date.]{.underline}]{.smallcaps} **[Anticipated Project
Completion Date is :]{.smallcaps}**
\_\_\_\_\_\_/\_\_\_\_\_\_/200\_\_\_\_\_

**[permit application - part A. -]{.underline}** **[[Project
Information]{.underline}]{.smallcaps}** [[&]{.underline}]{.smallcaps}
**[[General Activities (20.11.20.15 nmac)
(continued)]{.underline}]{.smallcaps}**

**13.** ([check one box) active operations will be the total area to be
disturbed]{.smallcaps} □[,]{.smallcaps} [**[OR]{.underline}**, active
operations will be phased]{.smallcaps} □

**14.** [If phasing of active operations]{.smallcaps} (Explain Phasing
Plan and include Total Disturbed Area, in acres, at any given time)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**15.** [Is a site drainage plan required for this project]{.smallcaps}?
[yes]{.smallcaps}\_\_\_\_\_ [no]{.smallcaps}\_\_\_\_\_\_

**16.** [If yes to]{.smallcaps} **[#15]{.smallcaps}** [above, is
drainage plan approved and available upon request by the
department]{.smallcaps}? [yes]{.smallcaps}\_\_\_\_\_\_
[no]{.smallcaps}\_\_\_\_\_\_\_

**17.** [Expected volume of bulk material (on site fill, imported fill,
base coarse gravel, Etc.) to be handled during the duration]{.smallcaps}

[of this project]{.smallcaps} (in cubic yards)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**18.** [Volume of bulk material to be imported to this project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**19.** [Address of Location]{.smallcaps}([s]{.smallcaps}) [from which
bulk material will be imported to this project
site]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**20.** [Do the bernalillo cnty. locations, providing bulk material to
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**21.** [Volume of bulk material to be exported from project
site]{.smallcaps} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_yds^3^

**22.** [Address of location(s)]{.smallcaps} [in bernalillo cnty. that
will receive bulk material exported from this project
site\_\_]{.smallcaps}\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**23.** [Do the bernalillo cnty. locations, receiving bulk material from
this project, have fugitive dust control permits?]{.smallcaps}

[yes \_\_\_\_no \_\_\_\_ unknown\_\_\_\_]{.smallcaps}

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23
nmac)]{.underline}]{.smallcaps}** **The "PERMITTEE" shall include in the
permit application one or more of the applicable reasonably available
control measures given in Part B.1 -- B.12 below,** **[OR]{.underline}**
**one or more other (alternative) fugitive dust control measures,
including measures taken to comply with any other statute or regulation
that would also effectively control fugitive dust during active and
inactive operations or construction activity** **(20.11.20.23 NMAC).**

**NOTE: If the "PERMITTEE" chooses to submit, as an attachment to this
application, an alternative fugitive dust control plan** **[in lieu of
the control measures given in Part B.1 -- B.12 below]{.underline}, the
alternative fugitive dust control plan (such as a storm water pollution
prevention plan) must include detailed information that addresses: 1)**
**the steady ongoing Reasonably Available Control Measures to mitigate
the release of Fugitive Dust from Active and Inactive Disturbed Surface
Areas; and 2) fugitive dust control Contingency Measures that will be
used; and 3) action(s) to be taken to mitigate property damage (see Part
C of this application). If submitting an alternative fugitive dust
control plan you still must complete and initial Parts** **[A, D, E, F,
G, H]{.smallcaps}, and** **[I]{.smallcaps}** **(if utilized) of this
application.**

**1.** **[Unpaved roadways]{.underline}** **\[check applicable
box(es)\]:**

a.□ paving using recycled asphalt, asphaltic concrete, concrete, or
petroleum products legal for such use;

> b.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}
>
> c\. **X** using wet suppression;
>
> d\. **X** using traffic controls, including decreased speed limits
> with appropriate enforcement; other traffic calming methods, vehicle
> access restrictions and controls; road closures or barricades; and
> off-road vehicle access controls and closures;
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2.** **[Paved roadways]{.underline}** **\[check applicable
box(es)\]:**

> a\. **X** cleaning up spillage and track out as necessary to prevent
> particulates from being pulverized and entrained into the atmosphere;
>
> b.□ using paved or gravel entry/exit aprons with devices, such as
> steel grates, capable of knocking mud and bulk material off vehicle
> tires;
>
> c.□ using on-site wheel washes;
>
> d.□ performing regularly scheduled vacuum street cleaning or wet
> sweeping with a sweeper certified by the manufacturer to be efficient
> at removing particulate matter having an aerodynamic diameter of less
> than 10 microns (i.e. PM~10~);
>
> e.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**3.** **[Trucks hauling bulk materials on public and private
roadways]{.underline}** **\[check applicable box(es)\]:**

> a\. **X** using properly secured tarps or cargo covering that covers
> the entire surface area of the load;
>
> b.□ preventing leakage from the truck bed, sideboards, tailgate, or
> bottom dump gate;
>
> c.□ using wet suppression to increase moisture content of the bulk
> materials being hauled;
>
> d.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}
>
> e.□ maintaining a minimum of 6 inches of freeboard below the rim of
> the truck bed. Freeboard means the vertical distance from the highest
> portion of the load abutting the bed and the lowest part of the top
> rim of the truck bed abutting the load;
>
> f.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Short term** control measures shall include (check this box
> first if utilizing short term measures listed below):

a\. **X** wet suppression;

> b.□ dust suppressants applied in amounts, rates, and maintained as
> recommended by the manufacturer; [submit manufacturer's information as
> an attachment to this application]{.smallcaps}
>
> c.□ temporary upwind windbreaks, including fabric fences with the top
> at least 4 feet above grade, and with the bottom of the fence
>
> sufficiently anchored to the ground to prevent material from blowing
> underneath the fence; all windbreaks and fabric fences shall be
> maintained in an upright and functional condition at all times until
> no longer needed to prevent or abate fugitive dust; all accumulated
> material on the windward side of the windbreak shall be periodically
> removed to prevent failure of the windbreak;
>
> d.□ watering the site at the end of each workday sufficient to
> stabilize the work area;
>
> e.□ applying dust suppressants in amounts and rates recommended by the
> manufacturer on the worksite at the end of each work week if no active
> operations are going to take place over the weekend or if active
> operations stop for more than two consecutive days;
>
> f.□ starting construction at the location that is upwind from the
> prevailing wind direction and stabilizing disturbed areas before
> disturbing additional areas;
>
> g.□ clean up and removal of track-out material;
>
> h.□ other (alternative)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5.** **[Active operations in construction areas and other SURFACE
disturbances]{.underline}** **\[check applicable box(es)\]:**

> **X** **Long term** control measures shall include (check this box
> first if utilizing long term measures listed below):
>
> a.□ site stabilization using dust suppressants applied in amounts and
> rates recommended by the manufacturer and maintained as recommended by
> the manufacturer; [submit manufacturer's information as an attachment
> to this application]{.smallcaps}

b.□ reseeding using native grasses as specified in 20.11.20.24 NMAC --
[native grass seeding and mulch specifications]{.smallcaps};

c.□ xeriscaping;

> d.□ installing parallel rows of fabric fencing or other windbreaks set
> perpendicular to the prevailing wind direction either onsite or on a
> nearby property with the permission of the nearby property owner;

e.□ surfacing with gravel or other mulch material of a size and density
sufficient to prevent surface material from becoming airborne;

f.□ mulching and crimping of straw or hay as specified in Section
20.11.20.24 NMAC;

g.□ installing permanent perimeter and interior walls;

h.□ conventional landscaping techniques;

i\. **X** clean up and removal of track-out material;

j\. **X** other (alternative) \_\_**Restrict access to inactive areas to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**6.** **[Bulk material handling]{.underline}** **\[check applicable
box(es)\]:**

a.□ using spray bars;

b.□ applying wetting agents (surfactants) to bulk material;

c.□ using wet suppression through manual or mechanical application;

> d.□ adding dust suppressants to bulk materials in amounts and rates
> recommended by the manufacturer and maintained as recommended by the
> manufacturer; [submit manufacturer's information as an attachment to
> this application]{.smallcaps}

e.□ reducing process speeds;

f\. **X** reducing drop heights;

g.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**7.** **[Industrial sites]{.underline}** **\[check applicable
box(es)\]:** **NA**

a.□ paving roadways and parking area with recycled asphalt, asphaltic
concrete, concrete, or petroleum products legal for such use;

b.□ performing regularly scheduled vacuum street cleaning or wet
sweeping;

c.□ regularly using wet suppression on unpaved areas;

> d.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

e.□ installing wind breaks;

f.□ installing enclosures;

> g.□ installing on-site anemometers to measure wind speed; the
> anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify on-site personnel of high winds;

h.□ increasing wet suppression applications before and during high wind
conditions;

i.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**8.** **[Demolition/renovation activities ([NON-asbestos containing
materials present]{.smallcaps})]{.underline}** **\[check applicable
box(es)\]:** **NA**

a.□ using constant wet suppression on the debris piles during
demolition;

> b.□ using water or dust suppressants on the debris pile, applied in
> amounts and rates recommended by the manufacturer; [submit
> manufacturer's information as an attachment to this
> application]{.smallcaps}

c.□ using enclosures;

d.□ using curtains or shrouds;

e.□ using negative pressure dust collectors;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9.** **[Milling, grinding or cutting of paved or concrete
surfaces]{.underline}** **\[check applicable box(es)\]:**

a\. **X** constantly using wet suppression;

b.□ ongoing clean up of milled, ground or cut material by using wet
sweeping;

> c.□ using dust suppressants applied in amounts, rates, and maintained
> as recommended by the manufacturer; [submit manufacturer's information
> as an attachment to this application]{.smallcaps}

d.□ using enclosures;

e.□ using curtains or shrouds;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**10.** **[Pressure blasting operations]{.underline}** **\[check
applicable box(es)\]:** **NA**

a.□ using non-friable abrasive material;

b □ using curtains, enclosures or shrouds;

c.□ using negative pressure dust collectors;

d.□ using constant wet suppression;

e.□ maintaining ongoing clean up of abrasive material;

f.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART B. -]{.underline}** **[[Reasonably
Available Control Measures (20.11.20.23 nmac)
(continued)]{.underline}]{.smallcaps}**

**11.** **[Spray painting and other coatings]{.underline}** **\[check
applicable box(es)\]:** **NA**

a.□ using enclosures that comply with applicable fire codes;

b.□ using curtains, enclosures or shrouds;

c.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**12.** **[High wind contingency measures]{.underline}** **\[check
applicable box(es)\]:**

**NOTE: It is required during a high wind event ([5 consecutive minutes
with an average wind speed of 30 miles per hour or higher]{.underline})
that** **[ALL]{.underline}** **fugitive dust sources cease all active
operations that are capable of producing fugitive dust; and continue to
use reasonably available control measures; and implement high wind
contingency measures.**

> a.□ installing and using on-site anemometers to measure wind speed;
> the anemometer should trigger a suitable warning mechanism such as a
> strobe light or audible alarm (that will not violate any applicable
> noise ordinance) to notify site personnel of high winds;

b\. **X** using constant wet suppression;

> c.□ using dust suppressants applied in amounts and rates recommended
> by the manufacturer; [submit manufacturer's information as an
> attachment to this application]{.smallcaps}

d.□ using wetting agents or surfactants on disturbed areas, bulk
materials or stockpiles;

e.□ other (alternative)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION - PART C. -]{.underline}** **[[fugitive dust
control plan (plan) (20.11.20.14 nmac)]{.underline}]{.smallcaps}**
**[(Print or Type)]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The "PERMITTEE" is required to comply with a
Fugitive Dust Control Plan that** **[details]{.underline}** **the
Fugitive Dust Control Measures that will be used to mitigate the release
of Fugitive Dust from Active and Inactive Disturbed Surface Areas. This
includes: 1) steady ongoing Reasonably Available Control Measures; and
2) fugitive dust control Contingency Measures; and 3) action(s) that
will be taken to mitigate claims of property damage.** **[[If you are
not]{.underline}]{.smallcaps}** **[submitting as an attachment to this
application an alternative fugitive dust control plan, then you must
complete Part C.1 - C.3 below to complete your Fugitive Dust Control
Plan.]{.smallcaps}**

**1**. [Describe in detail the steady ongoing]{.smallcaps} [Reasonably
Available Control Measures that you may have selected in Part B.1 --
B.12 of this application that will be used during this project to
mitigate the release of Fugitive Dust from Active Disturbed Surface
Areas (]{.smallcaps}any [current]{.underline} operation capable of
creating dust[) and Inactive Disturbed Surface Areas
(]{.smallcaps}previously disturbed areas where active operations are
temporarily suspended[). (]{.smallcaps}Some examples are: Provide
detailed information that may include the type, size and quantity of
equipment that will be used for wet suppression, and frequency of use;
Type of traffic control that will be used; Type and locations of fencing
or walls that will be installed; Type and frequency of use of vacuum or
wet sweeping that will be used; Location and type of temporary pavements
that will be used; Seeding plan; etc.).

[Active]{.smallcaps} -\_\_**Water trucks will be used to provide wet
suppression or hose connected to fire hydrant when
available**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Limit traffic flow at inactive sites to
maintain stable
surface**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**2**. [Describe in detail the additional fugitive dust control
Contingency Measures that will be used during this project if the
Reasonably Available Control Measures chosen in Part]{.smallcaps} b.[1
-- B.12 and detailed in Part C.1 above are determined by the department
to be insufficient to provide adequate Fugitive Dust
Control]{.smallcaps} [during Active and Inactive
Operations.]{.smallcaps}

[Active]{.smallcaps} -\_\_\_**Reduce speed of heavy equipment hauling
operations; wet areas to be disturbed prior to operations**\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Inactive]{.smallcaps} -\_\_**Restrict traffic on inactive
areas**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**3**. [Describe the action(s) that will be taken to mitigate claims of
property damage by fugitive dust generated at/from this
project]{.smallcaps}. **[It is required to remedy damage to real
properties caused by a violation of the permit (20.11.20.12.C
nmac).]{.smallcaps}**

\_\_\_**Will respond to reasonable claims of property damage. Will
provide for cleanup and/or repairs of affected
property**\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART - D. -]{.underline}** **[[high wind event
(20.11.20.16 nmac)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[NOTE]{.smallcaps}: A high wind event is a time period of 5
consecutive minutes with an average wind speed of 30 miles per hour or
higher.** **[ALL]{.underline}** **fugitive dust sources shall cease all
Active Operations that are capable of producing fugitive dust; and
continue to use Reasonably Available Control Measures; and implement
high wind contingency measures during a High Wind Event.**

**1**. [Describe in detail how the High Wind Contingency Measure(s)
chosen will be used during this project]{.smallcaps}\_\_\_**Cease
operations and maintain watering of site**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PERMIT APPLICATION PART -- E. -]{.underline}** **[[high wind
affirmative defense (20.11.20.16 nmac)]{.underline}]{.smallcaps}**

**[ATTENTION !!!]{.smallcaps}**

**[To assert a high wind affirmative defense,]{.smallcaps}** **[[the
permittee agrees to use one of the three]{.underline}]{.smallcaps}**
**[[Mandatory Control Measures shown below throughout the entire
duration of the permit]{.underline}, regardless of whether or not a high
wind event exists.]{.smallcaps}**

**[Do you wish to qualify for a High Wind Affirmative Defense during the
duration of this permit]{.smallcaps}?** **[yes]{.smallcaps}\_\_\_\_**
**[no]{.smallcaps}\_X\_\_**

**[If the answer to the above question is YES, then choose one of the
required Control Measures]{.smallcaps}** **[shown below]{.smallcaps}**

> 1[.]{.smallcaps}□ Using wet suppression sufficient to provide and
> maintain a soil moisture content of not less than 12 percent, and
> using properly maintained fabric fencing material around the perimeter
> of the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high); and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 2.□ Using chemical dust suppressants, in amounts and rates recommended
> by the manufacturer, sufficient to substantially reduce fugitive dust
> leaving the project area while Active Operations are idle, and using
> properly maintained fabric fencing material around the perimeter of
> the disturbed surface area with openings no wider than necessary to
> allow vehicles to enter or exit the area (fencing shall be anchored 6
> inches below the surface on the bottom edge and shall be 24 or more
> inches high), and during a High Wind Event ceasing all Active
> Operations but continuing to use all control measures.
>
> 3.□ Using an alternative dust control measure or measures that provide
> fugitive dust control that is equal to or better than using the
> measures described in options E.1 or E.2 above; and during a High Wind
> Event ceasing all Active Operations but continuing to use all control
> measures. If you choose to qualify for a High Wind Affirmative Defense
> and are selecting E.3, submit as an attachment the alternative dust
> control measure or measures for Department approval.

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac)]{.underline}]{.smallcaps}** **[(Print or Type)]{.smallcaps}**

[At the time of submittal, any person filing an application for a
Fugitive Dust Control Permit shall pay the applicable fees required. No
application will be reviewed or permit issued unless all applicable fees
have been paid. Construction Permits for Surface Disturbance require a
Filing & Review Fee, and an Inspection Fee.]{.smallcaps}

**[1. FILING & REVIEW FEE TABLE]{.smallcaps}**

  -------------------------------- -------------------- --------------------
  **[Total project acreage to be   **[filing & review   **[Check Appropriate
  disturbed]{.smallcaps}**         Fee]{.smallcaps}**   Box]{.smallcaps}**

  **¾ acre to less than 2 acres**  **\$250.00**         

  **2 acres to less than 5 acres** **\$350.00**         

  **5 acres to less than 15        **\$450.00**         
  acres**                                               

  **15 acres or greater**          **\$550.00**         
  -------------------------------- -------------------- --------------------

**NOTE:** **[the permittee shall install and maintain a project sign,
issued or approved by the Department, for all fugitive dust control
projects of 10 or more acres.]{.smallcaps}**

**[Inspection Fee[:]{.smallcaps}]{.underline}** **[-]{.smallcaps}** **To
calculate the fugitive dust control Inspection Fee below, which is in
addition to the above Filing & Review Fee, multiply the total project
acreage to be disturbed by the per - acre rate shown in the table below.
The total project acreage to be disturbed, used to calculate the
Inspection Fee below, must be expressed as a whole number. When
rounding, if the number after the decimal point is less than 5, the
whole number remains unchanged. If the number after the decimal point is
5 or greater, the whole number shall be rounded up to the next whole
number. Rounding of acres shall occur before the Inspection Fee is
calculated.**

2\. INSPECTION FEE TABLE

+--------------------------+----+---------------+---+------------------+
| **[Total project acreage | *  | **[Per Acre   |   | **[Inspection    |
| to be                    | *[ | Rate]{        |   | Fe               |
| disturbed]{.smallcaps}** | Ti | .smallcaps}** |   | e]{.smallcaps}** |
|                          | me |               |   |                  |
| **[(rounded to nearest   | s] | **[(based on  |   |                  |
| whole                    | {. | 20.11.2.15    |   |                  |
| number)]{.smallcaps}**   | sm | nmac)]{       |   |                  |
|                          | al | .smallcaps}** |   |                  |
|                          | lc |               |   |                  |
|                          | ap |               |   |                  |
|                          | s} |               |   |                  |
|                          | ** |               |   |                  |
+--------------------------+----+---------------+---+------------------+
|                          | *  | **\$100.00**  | * | **\$**           |
|                          | *x |               | * |                  |
|                          | ** |               | = |                  |
|                          |    |               | * |                  |
|                          |    |               | * |                  |
+--------------------------+----+---------------+---+------------------+

**[PERMIT APPLICATION PART -- F. --]{.underline}** **[[fees (20.11.2.15
nmac) (continued)]{.underline}]{.smallcaps}** **[(Print or
Type)]{.smallcaps}**

**[[Total Project Fee]{.underline}]{.smallcaps}** -- [Add the Filing &
Review Fee and the Inspection Fee from page 6 to determine the Total
Project Fee to be submitted with this application for a Fugitive Dust
Control Permit.]{.smallcaps}

3\. TOTAL PROJECT FEE TABLE

  ----------------------- ------------------------ ------------------------ ------- --------------------
  **[Filing & Review      **[Plus]{.smallcaps}**   **[Inspection                    **[Total Project Fee
  Fee]{.smallcaps}**                               Fee]{.smallcaps}**               Due]{.smallcaps}**

  \$                      **+**                    \$                       **=**   \$
  ----------------------- ------------------------ ------------------------ ------- --------------------

**NOTE: If an application to obtain a fugitive dust control permit is
submitted after active operations have commenced at the project
location, a late fee of 50 percent of the total project fee shall be
assessed in addition to the total project fee (20.11.2.17**
**[nmac).]{.smallcaps}** **In addition to this late fee for application
processing and permit issuance[,]{.smallcaps}** **civil penalty's may be
assessed** **pursuant to the New Mexico Air Quality Control Act, Chapter
74, Article 2 New Mexico Statutes Annotated 1978.**

**[Use the calculation below only if you are required to submit a late
fee.]{.smallcaps}**

**[Total Project Fee Due:]{.smallcaps}** **[\$]{.smallcaps}** **[X (1.5)
late fee factor =]{.smallcaps}** **[\$]{.smallcaps}** **[Total
Project/late Fee Due]{.smallcaps}**

**NOTE: Total Project Fee Due OR Total Project/Late Fee Due, required to
be paid at the time of application submittal, shall be paid by check or
money order payable to:** **[City of Albuquerque, Permits Program (Fund
242 -- Account \# 0421425)]{.underline}.** **Application and
accompanying fee may be delivered by mail to the address that appears at
the top of page 1 of this form or hand delivered to the same address
(between the hours of 8:00 am - 4:30 pm Mon. through Fri.). Call
768-1972 if hand delivering application and fee to insure that
appropriate staff is available to process a receipt.**

**[[PERMIT APPLICATION PART -- G. -- signature authority of permittee
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

**[NOTE:]{.smallcaps}** **This application shall include a fugitive dust
control plan that may utilize reasonably available control measures to
mitigate fugitive dust to meet the Objectives of Part 20.11.20 NMAC --
Fugitive Dust Control.** **By signing below, the applicant certifies
that the information provided in this application for a Fugitive Dust
Control permit is true, accurate and complete, and the applicant agrees
to be the "PERMITTEE". A "PERMITTEE" is a person, owner or operator and
all legal heirs, successors, and assigns who has applied for and
obtained a fugitive dust control permit approved by the Department. The
"PERMITTEE" agrees to take all actions required by the Fugitive Dust
Control permit issued by the Department to prevent a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping active
operations, if necessary.** **[The "PERMITTEE" is responsible for
complying with the fugitive dust control permit, the fugitive dust
control plan, and all requirements of Part 20.11.20 NMAC.- Fugitive Dust
Control. Failure to comply shall be a violation of Part 20.11.20 NMAC --
Fugitive Dust Control.]{.underline}**

[THE PERMITTEE SIGNATURE BOX MUST BE COMPLETED (**complete all
applicable information)**]{.smallcaps}

[\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print permittee's Business Name Email Address of Permittee Fax Number
of Permittee]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone Number of Permittee Cell Phone of Permittee Pager Number of
Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Permittee CITY State zip code]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Permittee]{.smallcaps} [Print
Title of Individual Signing for Permittee]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee]{.smallcaps} [Initials of Permittee]{.smallcaps}
[Date Submitted]{.smallcaps}

**[it is the responsibility of the permittee or designated responsible
person or official to ensure that the fugitive dust control permit or
amended permit contains current contact information and that
a]{.smallcaps}** **[[copy is maintained at the work site and is provided
to the department.]{.underline}]{.smallcaps}** **[failure to maintain
and provide up-to-date contact information shall be a violation of this
part. (20.11.20.18g nmac).]{.smallcaps}**

**[NOTE:]{.smallcaps}** **The applicant signing above and applying to be
the "Permittee", may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined in 20.11.20.7CC
NMAC (definitions), if the person(s) agrees in writing to be a
responsible person. A Responsible Person can be the Permittee, the
Owner, the Operator, or another Person(s). Before Department review and
issuance of a fugitive dust control permit, if the Permittee wishes to
designate a person(s) as a responsible person(s) for complying with all
or specific elements of the fugitive dust control permit, the fugitive
dust control plan, and Part 20.11.20 NMAC.- Fugitive Dust Control, then
Section I - signature authority of "Responsible Person" may be used at
the time of application submittal and must include all applicable
information concerning the designated Responsible Person(s). After the
issuance of the permit, the Department may approve in writing a permit
amendment to add or change a designated responsible person(s).
(20.11.20.14B NMAC)**

**[[PERMIT APPLICATION PART -- H. -- Owner or Operator Information
(20.11.20.15 nmac)]{.underline}]{.smallcaps}**

Complete the owner and/or operator information below [ONLY IF DIFFERENT
THAN THE PERSON WHO HAS SIGNED AS THE PERMITTEE IN SECTION
G]{.underline}, OR as a responsible person(s) in Section I of this
application for a fugitive dust control permit.

**[NOTE:]{.smallcaps}** **If the Permittee fails to comply with the
provisions of 20.11.20 NMAC -- Fugitive Dust Control, the Owner or
Operator, if different from a Responsible Person or the Permittee, shall
be responsible for complying with the permit. If the Permittee fails to
take all required actions to prevent a violation of 20.11.20 NMAC --
Fugitive Dust Control, the Owner or Operator or designated Responsible
Person, if different than the Permittee, shall be responsible to take
all actions required to prevent or satisfactorily resolve a violation of
20.11.20 NMAC -- Fugitive Dust Control, including stopping all active
operations, if necessary. To mitigate fugitive dust, all Inactive
Disturbed Surface Areas must be stabilized and maintained in stable
condition by the Owner, Operator, OR Person responsible for maintenance
of the disturbed surface. Failure to comply shall be a violation of
20.11.20 NMAC -- Fugitive Dust Control (20.11.20.12 NMAC).**

**[PROJECT O[WNER INFORMATION]{.smallcaps}]{.underline}** [(**complete
all applicable information)**]{.smallcaps}

[\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Owner's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Owner]{.smallcaps} [Print
Title of Individual Signing for Project Owner]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Owner]{.smallcaps} [Initials of Project
Owner]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Owner City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Owner Cell of Project Owner Pager of Project Owner Fax
of Owner]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Owner]{.smallcaps}

The **GENERAL PROVISIONS** of 20.11.20 NMAC -- Fugitive Dust Control
states that no person shall allow fugitive dust, track-out, or
transported material from any active operation, open storage pile, paved
or unpaved roadway or disturbed surface area, or inactive disturbed
surface area to be carried beyond the property line, right-of-way,
easement or any other area under the control of the person generating or
allowing the fugitive dust if the fugitive dust will: 1) adversely
affect the health, public welfare or safety of the residents of
Bernalillo county; or 2) impair visibility or the reasonable use of
property; or 3) be visible longer than a total of 15 minutes in any 1
hour observation period using the visible fugitive dust detection method
in 20.11.20.26 NMAC (visual determination of fugitive dust emissions
violations) or an equivalent method approved in writing by the
department.

**[project]{.underline}** **[[OPERATOR
INFORMATION]{.underline}]{.smallcaps}** [(**complete all applicable
information)**]{.smallcaps}

[\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Project Operator's Business Name]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Name of Individual Signing for Project Operator]{.smallcaps}
[Print Title of Individual Signing for Project Operator]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Project Operator]{.smallcaps} [Initials of Project
Operator]{.smallcaps} [Date Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Mailing Address of Project Operator City State Zip Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of Project Operator Cell of Project Operator Pager of Project
Operator Fax of Project Operator]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email Address of Project Operator]{.smallcaps}

**[[PERMIT APPLICATION PART -- I. -- signature authority of "Responsible
Person" (20.11.20.14 nmac)]{.underline}]{.smallcaps}** **[-
"]{.smallcaps}Responsible Person" means the person designated in a
permit who is responsible for complying with the permit, plan and
20.11.20 NMAC -- Fugitive Dust Control, to the extent specified in the
permit.**

**NOTE: If more than 1 individual will be designated a responsible
person at the time of this application submittal, make photocopies of
this page before completing any information. After the issuance of the
permit, the department may approve in writing an amendment to the permit
to add or change a designated responsible person(s).**

**The Permittee, may designate an additional person(s) \[includes an
entity(ies)\] to be a "responsible person" as defined above. If
different then the Permittee, a person that agrees in writing to be a
responsible person will be liable for violations of the permit, plan and
Part 20.11.20 NMAC -- Fugitive Dust Control and shall be the first
person contacted by the Department to resolve a violation of the permit
or Part 20.11.20 NMAC to the extent outlined below in the 'Active
Operation responsibilities** **of individual signing as a Responsible
Person' \[activity(ies)\][.]{.smallcaps}**

[\_\_\_\_\_\_\_\_\_\_\_**NA\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Print Responsible person's Business Name Print Name of individual
signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Print Title of individual signing as a Responsible Person Date
Signed]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of individual signing as a Responsible Person]{.smallcaps}
[Initials of individual signing as a Responsible Person]{.smallcaps}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

[address of individual signing as a Responsible Person City State Zip
Code]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Phone of individual signing as a Responsible Person Cell of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Pager of individual signing as a Responsible Person Fax of individual
signing as a Responsible Person]{.smallcaps}

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}

[Email of individual signing as a Responsible Person Active Operation
responsibilies of individual signing as a Responsible
Person]{.smallcaps} **[\[activity(ies)\]]{.smallcaps}**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[Signature of Permittee approving the designation of above individual as
a responsible person Date Signed]{.smallcaps}

**[NOTE:]{.smallcaps}** **By signing above as a Responsible Person you
will be designated in the permit issued by the Department as responsible
for complying with the permit, plan and Part 20.11.20 NMAC -- Fugitive
Dust Control to the extent specified in the above \[activity(ies)\]. You
will be responsible for the above \[activity(ies)\] for the duration of
the permit OR until such time as the Department receives a request from
the permittee to remove you from being the responsible person for the
above \[activity(ies)\]. The Permittee will become the responsible
person for the \[activity(ies)\] that a responsible person is removed
from, unless a new responsible person is designated for the same
\[activity(ies)\] and approved by the Department in writing.**

**[NOTE:]{.smallcaps}** **The Permittee or responsible person shall**
**[[maintain a current copy of the permit at the work
site]{.underline}]{.smallcaps}** **and make the permit available and
explain the requirements of the permit to appropriate employees, agents,
contractors, and any other person performing work in the area of active
disturbance to assist in maintaining compliance with Part 20.11.20 NMAC
-- Fugitive Dust Control.**

**[Pursuant to the Air Quality Control Act, Chapter 74, Article 2 New
Mexico Statutes Annotated 1978, as amended; the Albuquerque Joint Air
Quality Control Board Ordinance, 9-5-1-1 ROA 1994; the Bernalillo County
Joint Air Quality Control Board Ordinance, Bernalillo County Ordinance
94-5, and the Albuquerque/Bernalillo County Air Quality Control Board
(A/BCAQCB) Regulation Title 20, Chapter 11, Part 20, New Mexico
Administrative Code (NMAC), (20.11.20 NMAC) - Fugitive Dust Control, and
upon authorized signatures below, this application together with
associated drawings, plans, appended documents, other data, and any
conditions attached to the permit by the Department, will become the
Fugitive Dust Control Permit. Table Below For Department
Use.]{.smallcaps}**

+-------------------+---------+-------------------+---------+--------+
| **[application    | **[     | **[permit issued  | *       | **[e   |
| reviewed          | deemed] | b                 | *[issue | xpirat |
| b                 | {.small | y:]{.smallcaps}** | date]   | ion]{. |
| y:]{.smallcaps}** | caps}** |                   | {.small | smallc |
|                   |         |                   | caps}** | aps}** |
|                   | **[co   |                   |         |        |
|                   | mplete] |                   |         | **[d   |
|                   | {.small |                   |         | ate]{. |
|                   | caps}** |                   |         | smallc |
|                   |         |                   |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+

**[[PERMIT APPLICATION PART -- J. -- transfer of fugitive dust control
permit and plan (20.11.20.14 nmac)]{.underline}]{.smallcaps}**

**[attention: use this signature page only if transferring complete
responsibility of a current fugitive dust control permit and plan to a
new permittee.]{.underline}**

**[a fugitive dust control permit and plan may be transferred to legal
heirs, successors, and assigns, who shall become the new permittee.
transfers may be made as an administrative amendment provided
that:]{.smallcaps}**

**[1) a written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[is drafted between the current
and new permittee, and the project owner; and]{.smallcaps}**

**[2) a specific date is established for the transfer of the permit and
plan responsibility, coverage, and liability; and]{.smallcaps}**

**[3) department approval of written]{.smallcaps}** **[[transfer of
agreement]{.underline}]{.smallcaps}** **[has been
authorized.]{.smallcaps}**

**[there is no cost for transfer of the fugitive dust control permit and
plan if determined by the department that only administrative change is
needed. however, new application information must be submitted by the
new permittee or owner along with any applicable fees, if determined by
the department that necessary changes are required to complete
the]{.smallcaps}** **[[transfer of agreement]{.underline}]{.smallcaps}**
**[(particularly, any increase to the permitted 'total area to be
disturbed').]{.smallcaps}**

**[transfer of agreement signature box for current
permittee]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_na\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for current permittee requested
date for transfer of permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of current permittee initials of current permittee
submittal date of this page]{.smallcaps}**

**[transfer of agreement signature box for new permittee]{.smallcaps}**

[[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}]{.smallcaps}
**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[print new permittee business name requested date for acceptance of
permit and plan]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for new permittee print title of
individual signing for new permittee]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of new permittee initials of new permittee]{.smallcaps}**

**[by signing above as the new permittee, i agree to accept
responsibility, coverage, and liability for the existing]{.smallcaps}**

**[fugitive dust control permit
#\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and incorporated
fugitive dust control plan.]{.smallcaps}**

**[transfer of agreement signature box for project owner]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[printed name of individual signing for project owner date
signed]{.smallcaps}**

**[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.smallcaps}**

**[signature of project owner initials of project owner]{.smallcaps}**

**[by signing above as the project owner, i agree to the transfer of
responsibility of the existing fugitive dust control]{.smallcaps}**

**[permit #\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and
incorporated fugitive dust control plan to the above signed new
permittee.]{.smallcaps}**

**[[area below for department use]{.underline}]{.smallcaps}**

**[initial one of the conditions (a or b) given below]{.smallcaps}**

**A.) The department has determined that no change to the permit/plan
other than administrative change is necessary \_\_\_\_\_\_\_\_\_\_**

B.) The department has determined that necessary change(s) to the permit
and/or plan are required prior to transfer \_\_\_\_\_\_\_\_\_

+-------------------+---------+-------------------+---------+--------+
| **[permit         | **[     | **[transferred    | *       | **[e   |
| transfer of       | deemed] | perm              | *[issue | xpirat |
| agreement         | {.small | it]{.smallcaps}** | date]   | ion]{. |
| reviewed          | caps}** |                   | {.small | smallc |
| b                 |         | **[#\_\_          | caps}** | aps}** |
| y:]{.smallcaps}** | **[co   | \_\_\_\_\_\_\_\_\ |         |        |
|                   | mplete] | _\_\_\_\_\_\_\_\_ |         | **[d   |
|                   | {.small | issued            |         | ate]{. |
|                   | caps}** | b                 |         | smallc |
|                   |         | y:]{.smallcaps}** |         | aps}** |
|                   | *       |                   |         |        |
|                   | *[date] |                   |         |        |
|                   | {.small |                   |         |        |
|                   | caps}** |                   |         |        |
+-------------------+---------+-------------------+---------+--------+
| **[[              | **      | **[[              | **[[\_\ | *      |
| \_\_\_\_\_\_\_\_\ | [[\_\_\ | \_\_\_\_\_\_\_\_\ | _\_\_\_ | *[[\_\ |
| _\_\_\_\_\_\_\_\_ | _\_\_\_ | _\_\_\_\_\_\_\_\_ | \_/\_\_ | _\_\_\ |
| \_\_\_\_\_\_\_\_\ | /\_\_\_ | \_\_\_\_\_\_\_\_\ | \_\_\_/ | _/\_\_ |
| _\_\_\_\_\_\_\_\_ | \_\_\_/ | _\_\_\_\_\_\_\_\_ | 200\_\_ | \_\_\_ |
| \_\_\_]{.underlin | 200\_\_ | \_\_\_]{.underlin | ]{.unde | /200\_ |
| e}]{.smallcaps}** | ]{.unde | e}]{.smallcaps}** | rline}] | \_]{.u |
|                   | rline}] |                   | {.small | nderli |
| **[air quality    | {.small | **[air quality    | caps}** | ne}]{. |
| division          | caps}** | division          |         | smallc |
| supervisor or     |         | supervisor or     |         | aps}** |
| health            |         | health            |         |        |
| speciali          |         | speciali          |         |        |
| st]{.smallcaps}** |         | st]{.smallcaps}** |         |        |
+-------------------+---------+-------------------+---------+--------+