CN-370000-LE619-4I54183.pdf
PDF 231 KB Posted
- Contract number
- LE619
- Issued by
- Florida
About this file
This is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection (DEP), Office of Emergency Response (OER), for emergency response services. The document authorizes work to be performed by EQ Florida under Contract LE619 in response to DEP Incident #2015-4i-54183. The incident, dated December 2, 2015, involved abandoned hazardous waste pails discovered in Largo, Pinellas County, Florida, at the location of Floral Ave/Coral Way. The On-Scene Coordinator (OSC) for the incident was Jeff Tobergte, with Daniel McAllister serving as the contractor representative.
The work authorization covers the collection and transport of abandoned hazardous waste materials consisting of two 5-gallon pails containing lacquer thinner and motor oil, and one 5-gallon pail containing herbicide, antifreeze, and other hazardous materials. The work assignment is designated as fixed price with an estimated amount of $350.00. The contractor is responsible for overpacking the materials into a small open-head drum and delivering the wastes to EQ on December 3, 2015. Funding is provided through Project LE619 with Organization Code 37040100000, Object Code 139900, Fund 102577, and Category/Year 099001. The generator and transporter identification number is FL0000124784 (FL DEP/OER). No reimbursement potential was indicated for this work authorization, and all required signatures from the DEP representative, contractor representative, and OER budget representative were obtained on December 3, 2015.
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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
EQ Florida 2015-4i-54183
LE619 Daniel McAllister 12/2/15
Abandoned pails - Largo Jeff Tobergte
Floral Ave / Coral Way (813) 470-5954
Largo Pinellas (813) 267-3521
✔ OER will deliver the wastes to EQ on Thurs. 12/3/15.
✔ Abandoned pails, to be delivered to EQ by OER.
2 x 5-gal. pails lacquer thinner/motor oil. 1 x 5-gal. pail of herbicide/antifreeze/HazCat wastes.
See signed profiles for details and waste codes.
✔ 15 or 20-gal. open-head drum.
✔ manifest/LDR/labels/profiles.
The 2 lacquer thinner/oil pails need to be overpacked into a small open-head drum.
✔ See signed profiles. Generator and Transporter 1 is FL0000124784, FL DEP / OER.
350.00
LE619 37040100000 FC 139900 102577 099001 350. 00
Jeff Tobergte Tobergte_J Digitally signed by Tobergte_J Date: 2015.12.03 10:44:36 -05'00' 12/3/15
Daniel McAllister Daniel Mcallister Digitally signed by Daniel Mcallister DN: dc=com, dc=eqonline, dc=eqinternal, ou=EQ, ou=Users, ou=Standard Users, cn=Daniel Mcallister, email=Daniel.Mcallister@usecology.com Date: 2015.12.03 10:48:11 -05'00' 12/3/15
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2015.12.03 13:57:40 -05'00' 12/3/15
John Johnson John Johnson Digitally signed by John Johnson Date: 2015.12.03 13:41:56 -05'00'
File details come from the government source that posted it. Updated .