## Guidance for Filling 

## Out An Application for an Earthmoving Permit

The Application for an Earthmoving Permit Is At the End ofThisGuidance


## Section 1 

## -Applicant Information
Submitthe Appropriate Fee foryou Earthmoving Permit application, accordingto the following: If total surface area disturbed is 1.0 to 10acres, submit $75. Iftotal surface area disturbed is 10 acresor greater, submit $36/acreplus $1 10

### per site. Make checkspayable

### to "Gila River Indian Community, Department ofEnvironmental Quality". A Responsible Official is one ofthe following: For a corporation, a corporate officer or any other person who performs similarpolicy or decisionmaking functions for the corporation, or a duly authorized representativeof such person, if the representative is responsible for the earthmoving operation in the subject application.Delegation of authorityto such representative shallbe approved

### in advanceby the GRTC Department ofEnvironmental Quality. For apartnership or soleproprietorship, a general partner or the proprietor, respectively. For aFederal, or other public agency,the principle executive officerorranking elected official ofthat entity. 

## Section

## 2 

## -Project Information

## -Drawing Section 2 - Project Information -Drawing is self-explanatory. However, please remember, when calculating the amount of disturbed area for trenching, include the dimensions of the trench, stockpiling areas, and staging areas. 

## Section 

## 3 

## -Dust Control Plan
An Earthmoving Permit must contain a Dust Control Plan. You may fill-out Section 3 of the Application for an Earthmoving Permit and submit it as your Dust Control Plan or you may write your own Dust Control Plan describing all control measures to be used during the project and submit it as your Dust Control Plan. Water: Sources of fugitive dust, listed in Section 3, that include "~~~1~ water" as a control measure require specifics about water availability and water application. If you choose to apply water as a control measure, you must fill-in the blanks, under both Water Availability and Water Application. For Water Availability, indicate which of the following will be utilized: water storage tank on-site; metered hydrant on-site; water not on-site, describe water source and state the distance from site to water source; water provided through irrigation; other - specify source. For Water Application, indicate which of the following will be utilized: apply water using a water truck - state number of trucks and number of gallons per truck; apply water using hoses; apply water using sprinklers. 

### Dust Suppressants: Ifyou choosethe control measure "dust suppressant(s)otherthan water", you must describe the method of dust suppressant(s)application. Express frequency in terms ofhow often the surface will receive a complete application of dust suppressant(s) (i.e., the frequency may be three applications per day). Express intensity in units such as gallons per minute. Also, include as an attachment. Product specificationsor label instructionsfor approved usage. Information on environmental impacts and approvalsor certifications relatedto appropriateand safe use forground application. Any dust suppressantmust be approvedby the GRIC DepartmentofEnvironmental Quality.

## Continued 

# - Guidance for Filling Out 

## An Application for an Earthmoving Permit
Continued 

# -Section3 

## -Dust Control Plan Describing Major Project Phases:You may use the Project Information Drawing in Section2 to show the various project phases, along with a time line depicting relative start and stop times. Indicate on the line provided for describing major project phases that you have shown the various project phases on the Project Information Drawing. Bulk MaterialHandling and Hauling:Part V, Section 2.0 subsection 10.0 ofthe GRIC Air 

### QualityManagement Program Plan contains "Work Practices" that must be implemented for bulk material handling, storage, andortransporting operations. Work Practices apply to the use of equipment, haul trucks, andor motor vehicles, such as but not limited to the loading, unloading, conveying, transporting, piling, stacking, screening, grading, or moving of bulk materials, which are capable ofproducing fugitive dust at an industria1, institutional, commercial, governmental, construction, and/or demolition site. When designing your Dust Control Plan, you must choose control measures for all bulk material handling and bulk material hauling that you will do on-site within the boundaries ofthe work site and that you will do off-site onto paved public roadways. Open Storage Piles: The control measures for open storage piles are contained in Part V, Section 2.0 subsection 10.5 ofthe GRIC Air Quality Management Program Plan. Open Storage piles are defined as any accumulation (by stacking, loading, and unloading) ofbulk material with a 5% or greater silt content that in any one point attains a height of 3 feet and covers a total surface area of 150 square feet or more. If you choose to construct wind barriers around open storage piles, as a control measure, you must construct the wind barriers around three sides of the open storage pile. The walls of the enclosure must be no less than equal to the length ofthe pile; the height of the enclosure must be at least equal to the height ofthe pile; the distance of the pile from the sides ofthe enclosure must not be more than twice the height ofthe pile, and the material of which the sides are made must be no more than 50% porous. Spillage, Carry-Out, Erosion, and/or Track-Out: Part V, Section 2.0 subsection 10.3 of the GRIC Air Quality Management Program Plan requires spillage, carry-out, erosion, and/or track-out to be cleaned up at least at the end ofthe work day and immediately, if it extends more than 50 feet along a paved public roadway. You must specify, on the Dust Control Plan for any site that exits onto a paved public road, the control measures that you will use for both immediate cleanup and after-the-work-day clean-up. Surface Gravel, Recycled Asphalt, OrOther Suitable Material: Ifyou choose to "~~~1~ and maintain surface gravel, recycled asphalt, or other suitable materiai as a control measure for unpaved haullaccess roads, you must comply with one of the control measures in Table 1(Unpaved/Haul/Access Roads 1C-5C) of Part V, Section 2.0 of the GRIC Air Quality Management Program Plan: Do not allow visible dust emissions to 20% opacity and either do not allow silt loading to be equal to or greater than 0.33 oz/ft2or do not allow silt content to exceed 6%. If you choose to ''~~~1~ and maintain surface gravel, recycled asphalt, or other suitable materiaf as a control measure for unpaved parking lots, you must comply with the standards in Rule 310, Subsection 302.1 : Do not allow visible fugitive dust emissions to exceed 20% opacity and either donot allow silt loading to be equal to or greater than 0.33 oz/ft2or donot allow silt content to exceed 6%.

### Gila River Indian Communtiy Department of Environmental Quality Air Quality Program P.O. Box 97 / 

### 35 Pima Street Sacaton,

### AZ 85247 (520) 562-2234 

### FAX (520) 562-2245 

### PLEASE SUBMIT IN TRIPLICATE 

# Application for an Earth Moving Permit
Inorder forthe GRIC Department ofEnvironmental Qualityto process an applicationfor anEarthmoving Permit, all questions must be 

### answered and the appropriatefeemust be submitted. 

## Section 1 

## -Applicant Information 1. 

### Applicant Must Be One OfThe Following. Check

## AU ThatApply: Property Owner Developer GeneraVPrime Contractor Lessee 2. 

### Legal BusinessName: Applicant Address:

City/State/Zip: Phone: 

### Fax #: 

### Email Address: 

### 3. Property OwnerIDeveloper, IfNot Applicant: Address: Phone: 

### Fax #: Contact Person: 4. 

### Primary Project Contact: Title: Company Name: Pager #: 

### Mobile #: 

### On-Site #: 

### 5. 

### Signature ofa ResponsibleOficial ofthe Applicant: 

### I hereby 

### certify that, based on information and belief formed 

### after reasonable 

### inquiry, the statements and information in 

### the Application For An 

### Earthmoving Permit, including Section 1 -Applicant Information, Section 2-Project Information-Drawing, and Section 3-Dust Control Plan, are true, accurate, and complete. A Responsible Official of the Applicant is the person who will be contacted or named in any enforcement action initiated by the GRIC DepartmentofEnvironmental Quality orthe GRIC Tribal Courts. 

### Signature: PrintedName: Title:

## Section

## 3 

# -Dust Control Plan
Put a check 

## (4)in the box in front of all the following sources of fugitive dust that you anticipate from your project. Write the letters "NA" in the box in front of all the following sources of fugitive dust that you do not anticipate implementing during your project. Unless already pre-designated, write the letter -P", for primary control measures that you will implement during your project, on the line in front of at least one of the listed control measures or work practices, under each checked bodsource of fugitive dust. The control measures pre-designated with the letter "P" are required to be implemented. Write the letter Ic", for contingency control measures that you will implement during your project, on the line in front of at least one ofthe listed control measures or work practices, under each checked bodsource of fugitive dust. 

## LkJnpaved HauVAccess Roads: Limit vehicle speed to 15miles per hour or less and limit vehicular trips to no more than 

### 20 per day. If this is chosen as the primary control measure, indicate number of vehicles traveled on haul roads: Apply water at a frequency and intensity to comply with Subsection 3.1, of Part V, Section 

### 2.0 ofthe GRIC Air Quality Management Program Plan. Water Availability: Water Application:
Pave Apply and maintain surface gravel, recycled asphalt, or other suitable material sothat the area meets the silt loading and silt content limits of Subsection 

### 5.0, Part V, Section 

### 2.0 of the GRIC Air Quality Management Program Plan. Apply and maintain dust suppressant(s) other than water using at a frequency of and an intensity of Other: 

# - U~isturbed Surface Areas 

## -Before Dust genera tin^ 

## Operations Occur: Pre-water site to the depth ofcuts. Water Availability: Water Application:
Phase work to reducethe amount of disturbed surface area at any one time. Describe major project phases:

Other: 

## U~isturbed SurfaceAreas 

## -Durin~ Dust genera tin^ 

## OperationsOccur: ~pply water. Water Availability: Water Application:Apply and maintain dust suppressant(s) other than water using at a frequency of and an intensity of
Construct fences or 3 foot 

### - 5 foot high wind barriers with 50% or less porosity (in combination with one of the above) Show locations on drawing in Section 2.
Cease operations (as a contingency control measure only) Other:



### - 

## U~isturbed SurfaceAreas 

## -Temporaw Stabilization Includine Weekends, After Work Hours, Holidays, and Periods Up 

## to 8 

## Months: Apply water orother dust suppressant(s) 

### in sufficientquantity and frequency to establish and maintain a visible crust. Water Availability: Water Application: Restrict vehicular access in combination with one ofthe above. Other: 

## U~isturbed SurfaceAreas 

# -Permanent Stabilization Required Within 8 

## Months of Ceasinp Dust genera tin^

## Owrations: Restore area such that the vegetative ground cover and soil characteristics are similar to adjacent or nearby undisturbed native conditions.
Pave or apply gravel. Apply and maintain dust suppressant(s) other than water using at a frequency of and an intensity of 

## U Other:



## u~rackout from Work SitesWith 5 

## Acres Or More ofDisturbed SudaeeArea orWith 100 CubicYard OrMore ofBulkMaterial Hauled On or Off Site Per Day: Install a grizzly or wheel wash system at all accesspoint.
At all access points, install gravel pad at least 30 feet wide, 50 feet long, and 6 inches deep.
Pave starting from the point of intersectionwith a paved public roadway and extending for a centerlinedistance of at least 1OD feet and a width of at least 20 feet. 

## U Other: 

## Uspillape, Carw-Out. Erosion, andlor Trackout: IfExtending More 

### Than 50 Feet AlongA Paved Public Roadwav Implement 

### IMMEDIATELY:Operate a street sweeper or wet broom with sufficient water, if applicable, at the speed recommended by the manufacturer. 

### II] Manually sweep-up deposits. 

### II] Other (describe in detail): 

### If Extending LessThan 

### 50 FeetAlon~ A 

### Paved PublicRoadway LmplementNO LATER 

### THAN 

### THE END OF THE WORK DAY: Operate a street sweeper or wet broom with sufficient water, if applicable, at the speed recommended by the manufacturer Manually sweep-up deposits. 

### II] Other (describe in detail): 

## U~ehicle Use In Open Areas: II] Restrict trespass by installing signs. 

### II] Install physical barriers such ascurbs, fences, gates, posts, signs, shrubs ortrees to prevent access. Other:



## nun paved Parkinr Lots: [? Apply water at a frequency and intensity to comply with Subsection3.1 ofPart V, Section 2.0ofthe GRIC Air Quality Management Program Plan. Water Availability: Water Application:- Apply and maintain gravel, recycled asphalt, or other suitable material such that the area meets the silt loading and silt content limits of Subsection 4.0 of Part V, Section 2.0 of the GRIC Air Quality Management Program Plan. 

### II] Apply and maintain dust suppressant(s) other than water using at a frequency of and an intensity of
Other: 

# UBUI~ Material Handling and Open Storare Piles: (Choose Primary ControlMeasure and 

### Secondary Control Measure for Each ofthe Following Two (2) 

### Situations) 

## Durinr Stacking, Loading, and Unloadinp Operations: Apply water at a frequency and intensity so as not to exceed 20% opacity. Water Availability: Water Application: 

### [? Other:

## When Not 

## conduct in^ Stacking, Loading, and 

## unload in^ Operations: Cover open storage piles with tarps, plastic, or other material. Apply water to maintain soil moisture content at a minimum of 12% or 70% of the optimum moisture content for compaction. Water Availability: Water Application: Apply water as needed to establish and maintain a visible crust. Water Availability: Water Application: Construct windbaniers. This control measure must be used in combinationwith at least one ofthe above control measures, except covering. Other:

## UBulk Material Haulinr On-SiteWithin TheBoundaries ofthe Work Site:

Load all haul trucks such that the freeboard is not less than 3 inches; and Prevent spillage or loss ofbulk material from holes or other openings in the cargo compartment's floor, sides, and/or tailgates, and Install a trackout control device that removes particulate matter from tires and the exterior stlrfaces of haul trucks and/or motor vehicles that traverse the work site. Limit vehicular speeds to 15 miles per hour or less while traveling on the work site. Apply water to the top of the load. Water Availability: Water Application: Cover haul trucks with a tarp or other suitable closure. Other: 

## UBulkMaterial Haulinp Off-Site Onto Paved Public Roadwavs: Cover haul trucks with a tarp or other suitable closure; and Load all haul trucks such that the freeboard is not less than 3 inches; and Prevent spillage or loss ofbulk material from holes or other openings in the cargo compartment's floor, sides, and/or tailgate(s); and Before the empty haul truck leaves the site, clean the interior of the cargo compartment or cover the cargo compartment. Other: 

## U~arthmoviw Operation On Disturbed Surface Areas 1

## Acre Or Larper: Apply water while conducting earthmovingoperations Water Availability:Water Application:- Other: