CN-370000-HW684-DC041A.pdf

Funding Information:

Org. Code E.O. Object Code Budget Entity Appropriation

Category Grant # Project # Year Amount

☐ Additional Funding Information attached on separate page.

Rev. 8/26/2020

STATE OF FLORIDA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

Task Assignment This Task Assignment (TA) is entered into between the Parties named below, pursuant to Contract Number: .

1. TA Number: TA Completion Date:

TA Description:

2. Parties State of Florida Department of Environmental Protection

(Department)

Department Project Manager: Department Project Manager Phone:

Contractor Name: (Contractor ) ntractor’st ’s Project Manager: ontractor’s t’s Project Manager Phone:

3. Project Number:

(If different from TA Number)

Project Location(s):

Project Name:

4. As consideration for the services rendered by Contractor under the terms of this TA, the Department shall pay the Contractor on the following bases, up to the Total TA Value as indicated below:

☐ Fixed Price:

☐ Fixed Unit Rate: (Extended Price)

☐ Cost Reimbursement:

Total TA Value:

5. The Parties agree to comply with the terms and conditions of the underlying the Contract, and the following attachments which are hereby incorporated by reference:

Attachment 1:

☐ Additional Attachments (if necessary):

IN WITNESS WHEREOF, this TA shall be effective on the last date signed below.

State of Florida Department of Environmental Protection CONTRACTOR Department Name:

Title:

Secretary or Designee

(Authorized Signature) (Authorized Signature) Date:

☐ Additional signatures attached on separate page.

HW684

DC041A Completion July 28, 2023

This Task Assignment authorizes GHD Services, Inc. to generate a Site Assessment Work Plan for the Becky's Valet site located in Tampa, FL in accordance with the attached Site Assessment Work Plan Task List.

Kevin Kane 850-245-8971 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

GHD Services, Inc.

GHD Services, Inc.

Brian Moore 813-257-0658

ERIC_4773

3841 Neptune St, Tampa, Hillsborough County

Becky's Valet

✔ $ 5,000.00

$ 5,000.00

Scope of Work

Brian Moore

Project Manager

Brian Moore Digitally signed by Brian Moore Date: 2023.05.17 12:58:58 -04'00'

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.05.15 09:26:06 -04'00'

N/A

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WCP TAFORM 04-2017

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

Site Assessment Work Plan; Project Management 06/23/2023

Subtasks 1 & 2: Upon submittal and FDEP approval of the Site Assessment Work Plan + Project Management $ 5,000.00

$ 5,000.00

HW684

DC041A

Site Assessment Work Plan (SAWP) Task List

Site Review:

1. Information Portal/ERIC/OCULUS Review

a. Review applicable documents

b. Application

c. Site Screening Report

d. Other assessment data

e. Permitting/Compliance/Enforcement history

2. Additional information as available and as needed

a. Google maps, aerial photographs, topographical maps, building/planning department records, land use maps, insurance maps

b. Other regulatory agency records

c. Contact DC operator for operations history. May be able to find operator even if DC is no longer operating

Site Visit:

1. Complete Drycleaning Site Visit Checklist

2. Verify Site Screening Report information, especially sample location(s)

3. Identify likely source/release areas (machine location, service door, floor drains, lint trap, sewer line, septic tank, dumpster, ASTs/USTs). Look for evidence on floors/walls for former machine location.

4. Identify above/below ground utilities and potential impediments to assessment activities

5. Verify accuracy of site map, revise as necessary

6. Interview operator/owner for site history

7. Discuss work plan elements with property owner and get direction regarding approach to tenants, and schedule.

SAWP:

1. Completed Drycleaning Site Visit Checklist

2. Site summary/narrative – Initial conceptual site model (brief text)

- Current status and history of DC operations

- Primary solvents used both prior to and after eligibility determination

- Owner/operator/tenant information

- Status of site structures (original, renovated, razed/redeveloped, vacant)

- Historical site assessment/remediation information

- Anticipated lithology, depth to water, and groundwater flow direction

- Known or anticipated source areas -Site Assessment Approach

3. Figures

- Topo

- Site features, aerial view, facility layout, waste storage areas, utilities, etc.

- Proposed sampling locations (soil, MAGS, DPT profiling, MWs, sediment, surface water, sewer/septic/lint trap)

4. Sampling Plan/Checklist (templated, see Word SAWP Summary Checklist) - Including proposed number of samples for soil, MAGs, groundwater, etc.

5. Proposed schedule from approval of SAWP to submittal of SAR

6. Cost Estimate (CE)/Level of Effort (LOE) Worksheets, including subcontractor quotes, as appropriate. The CE/LOE should be submitted upon approval of the SAWP and under separate cover.

Notes: 1) No documents that are available in ERIC or HASPs should be included with the SAWP, 2) No EDR or other ESA-like reports are required, 3) No offsite property owner/use or well survey information is required, 4) No potable well survey, 5) SOW should include PFAS screening (see guidance)