CN-370000-LE619-4I54106.pdf
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- Contract number
- LE619
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response, for emergency response services. The document authorizes US Ecology to perform spill response work at an abandoned drum site located on Anderson Road at CR 640 in Mulberry, Polk County, Florida. The incident (DEP Incident # 2015-4I-54106) was reported on November 16, 2015, with on-site work scheduled for November 18, 2015 at 10:00 hours. Daniel McAllister served as the DEP representative, and Timyn Rice was the On-Scene Coordinator.
The authorized work involves removing spilled hardened resin from the ground and overpacking two 55-gallon drums of flammable resin (containing D001 and F003 hazardous waste) for disposal to a Treatment, Storage, and Disposal Facility (TSDF). The scope requires one supervisor and two recovery technicians, utilizing a response truck and overpack drums. The work is assigned as a fixed-price cost estimate with an estimated amount of $2,500.00. Reimbursement potential was identified as "no" for OPA-'90 reimbursement or responsible party reimbursement. Funding was approved under Project Number LE619, Organization Code 3704010000, Fund 102577, and Category/Year 099001, with the full $2,500 amount allocated from Florida's general fund.
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Text version
Florida Department of Environmental Protection
Office of Emergency Response
WORK AUTHORIZATION FORM
Required Signatures: Adobe Signature or Original Ink Supplemental WAF
Contractor: ____________________________________ DEP Incident # ______________________ Contract #: ___________ Rep: ____________________ Incident Date _______________________ Site Name: ____________________________________ OSC: ______________________________ Location: ______________________________________ Phone: Office______________________ City: __________________County: _________________ Cell ________________________
Description of Work: Respond Immediately Call OSC to set date/time__________________________________
Spill Response Overpack Drums Transport drums to TSA Abandoned Drum:
Remove Soil Sampling Transport Drums to TSDF Analysis of samples collected by OER
Other:
Suspected Materials, and amounts: _____________________________________________________________________________________
Level of Effort: (Check all that apply) Use Subcontractor per OSC
Personnel Vehicles Equipment
Supervisor: ____ Response Truck Overpack Drums: Visqueen
Recovery Tech: ____ Straight Truck 55-gal. Drums: Roll-off Containers: ___________
Field Chemist: ____ Vacuum Truck Sampling Gear EPA Level 1 Vapor Detector
Equip. Oper.: ____ Pickup or Van Sampling Gear EPA Level 2 PPE Level: __________________
Other: ____________ Backhoe or Similar Other: ________________ MOT
Other: ____________ Other: ____________ Other:______________________
Comments: ___________________________________________________________________________________________________________
Analytical & Disposal Arrangements: (analytical will usually be listed on Chain-of-Custody or other form)
Via Contractor Via Subcontractor Other: ________________________________________________
Profile Wastes as:
Work Assignment Type: fixed price cost estimate est’d amount: $____________________________
Reimbursement Potential: no yes OPA-’90 reimbursement Resp. Party Reimbursement
Funding Information: (information provided by OER budget rep., budget rep to sign after WAF executed, but prior to transmittal to F&A)
Project No. Organization Code EO Object Code Fund Category/Yr
Module/ OCA Grant Amount
Approved:
DEP Representative: __________________________ Signature: _______________________________ Date: __________________
Contractor Rep: __________________________ Signature: ___________________________________ Date: __________________
OER Budget Rep: __________________________ Signature: __________________________________ Date: __________________ OER_13 (Effective 9-14-2015)
Prior Approval received by printed name: Signature
US Ecology 2015-4I-54106
LE619 Daniel McAllister 11/16/15
Abandoned Resin Drums Timyn Rice
Anderson Road at CR 640 (813) 470-5919
Mulberry Polk (813) 267-3609
✔ Shoot for 11/18 at 1000 hrs
✔ Remove spilled hardened resin from ground
2 x 55 gallon drums of flammable resin with some spillage (hardened). Overpack both 55 gallon drums for disposal. Shovel (or rake) hardened spilled resin into 55 gallon drums. Bring 2 x 85 gal overpacks and 2 x 55 gal drums.
✔ 2
D✔
✔ D001, F003 RQ, UN1866, Waste Resin Solution, 3, PGIII. Hardened resin from ground non-haz/non-reg
✔ 2,500.00
LE619 37040100000 FL 139900 102577 099001 2500 00
Timyn Rice Date: 2015.11.17 15:30:15 -05'00' 11/17/15
Daniel Mcallister Digitally signed by Daniel Mcallister DN: cn=Daniel Mcallister, ou=EQ, Users, Standard Users, email=Daniel.Mcallister@eqonline.com, dc=com, eqonline, eqinternal Date: 2015.11.17 15:50:27 -05'00'
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2015.11.19 09:19:43 -05'00' 11/19/15
John Johnson John Johnson Digitally signed by John Johnson Date: 2015.11.19 09:17:02 -05'00' daniel_m Text Box Daniel McAllister daniel_m Text Box 11/17/15
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