CN-370000-LE619-4I55125.pdf
PDF 201 KB Posted
- Contract number
- LE619
- Issued by
- Florida
About this file
This Work Authorization Form (WAF) is issued by the Florida Department of Environmental Protection, Office of Emergency Response, authorizing U.S. Ecology/EQ Florida to respond to an environmental incident. The document, dated April 20, 2016, pertains to DEP Incident #2016-4I-65125, with On-Scene Coordinator Domenic LetoBarone overseeing the response. The incident occurred in Ruskin, Hillsborough County, Florida, at Chaney Drive (GPS coordinates N 27.68892, W -82.46301), and involves the removal of an abandoned drum reported on April 18, 2016.
The work assignment is classified as a fixed-price contract valued at $700.00 and involves the recovery and overpack of one 55-gallon blue polyethylene drum containing approximately 30 gallons of used motor oil and gasoline located on county right-of-way. The scope of work includes deploying one recovery technician and one field chemist, utilizing a lift gate vehicle, and transporting the overpacked drum to a treatment storage and disposal facility (TSDF). The suspected materials are profiled as hazardous waste (Oil, Haz - per contract), with EPA waste codes D001, D006, D007, D008, D018, F003, and F005. Analytical and disposal arrangements are to be handled via the contractor. The funding is allocated from Project LE619, with the amount of $700.00 approved and charged to Organization Code 37040100000, Fund 099001, and Object Code 102577.
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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)
U.S. Ecology/EQ Florida 2016-4I-55125
LE619 Daniel McAllister unknown (reported on 4/18/2016) abandoned blue poly 55-gal. drum (used oil & gasoline) Domenic LetoBarone
Chaney Drive (N 27.68892, W -82.46301) (813) 470-5954
Ruskin Hillsborough (813) 299-3608
✔ Would like to meet tomorrow morning if possible
✔ ✔ ✔ 1
1 x 55-gallon blue poly drum containing approximatley 30-gallons of used motor oil & gasoline
The drum is upright and located on County Right-of-Way on the North side of Chaney Drive (see GPS coordinates above)
Work Clothes, Gloves lift gate
✔ Labels, Manifest, Paperwork
The 55-gallon drum has a date stamp from 1997. Please place the poly 55-gal. into an overpack drum for transport
✔ [Oil, Haz - per contract], D001, D006, D007, D008, D018, F003, F005
700.00
LE619 37040100000 FL 139900 099001 102577 $700. 00
Austin Hofmeister Austin Hofmeister Digitally signed by Austin Hofmeister Date: 2016.04.20 12:29:12 -04'00' 4/20/16
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: 2016.04.20 13:31:00 -04'00' 4/20/16
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2016.04.20 14:15:03 -04'00' 4/20/16
File details come from the government source that posted it. Updated .