CN-370000-LE619-4I54279.pdf
PDF 231 KB Posted
- Contract number
- LE619
- Issued by
- Florida
About this file
Work Authorization Summary
This document is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response. The form authorizes work to be performed by US Ecology under Contract #LE619 in response to DEP Incident #2015-4I-54279. The incident occurred on December 12, 2015, at Buffalo Road at Lakehurst Court in Palmetto, Manatee County, Florida. The On-Scene Coordinator (OSC) is Jamie Arleo, with contact numbers (813) 470-5954 and (813) 267-3561.
The work scope includes overpacking a 30-gallon drum of used oil and used oil filters into a 55-gallon drum and shoveling contaminated soil into a 55-gallon drum for transport to a Treatment Storage Disposal Facility (TSDF). The materials are profiled as non-hazardous used oil. The work assignment is designated as fixed price with an estimated amount of $1,000.00. One supervisor and one recovery technician are assigned, along with a response truck and two 55-gallon drums as equipment, with PPE Level D required. The work was authorized for December 17, 2015, at 10:00 AM. Funding is allocated under Project No. LE619, Organization Code 37040100000, Fund 102577, Category/Year 099001, with no reimbursement potential. All required signatures from the DEP Representative, Contractor Representative, and OER Budget Representative were obtained between December 15 and December 30, 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
US Ecology 2015-4I-54279
LE619 Daniel McAllister 12/12/15
Abandoned Drum Jamie Arleo
Buffalo Rd. at Lakehurst Ct. (813) 470-5954
Palmetto Manatee (813) 267-3561
✔ 12/17/15 at 10:00 am
✔ ✔ 1x30g
1 x 30 gallon drum of used oil and used oil filters. Overpack drum into 55-gallon drum.
Shovel contaminated soil into 55-gallon drum.
✔ 1
D✔
✔ Used oil, non-hazardous.
1,000.00
LE619 37040100000 FL 139900 102577 099001 $1000. 00
Jamie Arleo Arleo_J Digitally signed by Arleo_J Date: 2015.12.15 15:55:24 -05'00' 12/15/15
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: 2015.12.15 16:06:37 -05'00' 12/15/15
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2015.12.30 10:15:07 -05'00' 12/30/15
John Johnson John Johnson Digitally signed by John Johnson Date: 2015.12.30 13:12:52 -05'00'
File details come from the government source that posted it. Updated .