CN-370000-LE619-4I54203.pdf
PDF 232 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, authorizing emergency response services from EQ Florida, Inc. under contract LE619EQ. The work was authorized on December 4, 2015, for incident 2015-4I-54203, which involved an abandoned 55-gallon drum of waste resin discovered on December 4, 2015, in a roadside ditch along C.R. 640 west of Anderson Road in Mulberry, Polk County. The On-Scene Coordinator (OSC) was Domenic LetoBarone, with the response scheduled for Tuesday, December 8, 2015, at 2:00 PM.
The contractor was tasked with removing and disposing of the abandoned 55-gallon metal drum containing partially solidified, flammable waste resin from standing water in the roadside ditch. The work required one supervisor and one recovery technician, utilizing a vehicle with a lift gate and winch, overpack drums (1x85-gallon), work clothes, and all necessary paperwork, labels, and placards. The waste was profiled as D001 and F003 hazardous waste and was to be placed in an 85-gallon overpack for transport and disposal via EQ. The work assignment was fixed-price at $1,119.00 with no reimbursement potential. Funding was provided through DEP project LE619, organization code 37040100000, object code 139900, fund 102577, and category/year 099001.
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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, Inc. 2015-4I-54203
LE619EQ Mr. Daniel McAllister unknown, discovered 12/4/2015
55-gallon waste resin drum Domenic LetoBarone
C.R. 640, west of Anderson Road, in the north-side ditch (813) 470-5954
Mulberry Polk (813) 299-3608
✔ Respond Tuesday December 8th at 2:00 pm.
✔ ✔ ✔ 1x55
✔ abandoned 55-gallon drum removal and disposal
55-gallon metal drum of waste resin, dumped in a roadside dicth of standing water
Contractor will need a vehicle with a lift gate and a winch to remove the drum from the ditch.
1x85
Work Clothes lift gate & winch
✔ All necessary paperwork, labels, and placards
1 x 55-gallon drum of waste resin. Place drum into an 85-gallon overpack for transport and disposal via EQ. (see photos)
✔ D001, F003 (drum contains partially solidified resin waste, flammable); FL DEP, EPA ID# FL0000124784
1,119.00
LE619 37040100000 FL 139900 102577 099001 1119. 00
Domenic LetoBarone Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2015.12.04 16:32:06 -05'00' 12/4/15
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: 2015.12.07 08:37:35 -05'00' 12/7/15
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2015.12.08 09:33:44 -05'00' 12/8/15
John Johnson John Johnson Digitally signed by John Johnson Date: 2015.12.04 16:37:59 -05'00' letobarone_d Highlight
File details come from the government source that posted it. Updated .