CN-370000-LE619-4I54699.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 (FDEP), Office of Emergency Response, for emergency response services. The form authorizes work to be performed by EQ Florida / U.S. Ecology under Contract LE-619 for DEP Incident #2016-4I-54699, dated February 18, 2016. The incident involves an abandoned 55-gallon drum of ignitable paint waste and solvents located at Spring Green Drive and Livingston in Lutz, Hillsborough County, Florida. Domenic LetoBarone serves as the on-scene coordinator, with Jeff Tobergte designated as the primary on-scene contact.
The work authorization specifies a fixed-price cost of $900.00 for services including drum overpack, transport of drums to a Treatment, Storage, and Disposal Facility (TSDF), and proper labeling and paperwork. Personnel assigned include one supervisor and one field chemist. Equipment mobilized includes one 85-gallon over-pack drum, a straight truck with lift-gate capability, a drum dolly, and all necessary paperwork and labels. The hazardous waste is classified under EPA codes D001, D008, D035, F003, and F005. Funding is allocated from Project LE619, Organization Code 37040100000, with funding approval documented and signed by DEP Representative Domenic LetoBarone, Contractor Representative Daniel McAllister, and OER Budget Representative Amanda Hartsfield, with approvals dated February 19-25, 2016.
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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 / U.S. Ecology 2016-4I-54699
LE-619 Dan McAllister 2/18/2016
Abandoned 55-gallon drum of ignitable paint waste/solvents Domenic LetoBarone
Spring Green Drive and Livingston (813) 470-5920
Lutz Hillsborough (813) 299-3608
✔ schedule pick up for today, around 10:00 a.m. if possible
1 x 55-gallon metal drum full of ignitable liquid paint waste/solvents
*** Please contact Jeff Tobergte, he will be your on-scene contact, (813) 267-3521 ***
1 x 85
Level D drum dolly lift-gate
✔ all necessary paperwork and labels
1 x metal 55-gallon drum. will require an 85-gallon over-pack. The drum is full of liquid paint waste/solvents
✔ waste paint related material; D001, D008, D035, F003, F005
900.00
LE619 37040100000 FL 139900 099001 102577 $900. 00
Domenic LetoBarone Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2016.02.19 08:43:48 -05'00' 2/19/16
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: 2016.02.19 08:51:10 -05'00' 2/19/16
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield DN: cn=Amanda Hartsfield, o=Emergency Response, ou=FL Dept. Environmental Protection, email=Amanda.Hartsfield@dep.state.fl.us, c=US Date: 2016.02.25 08:36:14 -05'00' 2/25/16
John Johnson John Johnson Digitally signed by John Johnson Date: 2016.02.23 13:08:07 -05'00' letobarone_d Highlight letobarone_d Highlight letobarone_d Highlight
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