CN-370000-LE619-4I55298.pdf
PDF 228 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 (US Ecology). The incident, numbered 2016-4I-55298C, occurred on May 11, 2016, at 319 Manatee Drive and East Ravine Drive in Ruskin, Hillsborough County. The authorized representative for the contractor is Daniel McAllister, and the On-Scene Coordinator is Domenic LetoBarone, with oversight coordination scheduled for May 12, 2016, at 8:30 AM.
The work authorization covers spill response and hazardous waste management services, specifically the overpacking and transport of two drums of biodiesel waste and one 5-gallon bucket of biodiesel-contaminated soil to a Treatment, Storage, and Disposal Facility (TSDF). The suspected materials are classified as hazardous waste, liquid and solid (n.o.s.) with F003 designation. The work assignment is structured as a fixed-price contract with an estimated amount of $2,000.00. Two field chemists are assigned to the response, which includes use of a response truck and overpacking drums. The waste will be profiled and transported under no reimbursement potential, with funding allocated from DEP Project LE619 (Organization Code 37040100000, Object Code 139900, Fund 099001, Module 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)
Prior Approval received by printed name: Signature
EQ Florida (US Ecology) 2016-4I-55298C
LE619 Daniel Mcallister 05/11/2016
Biodiesel drums Domenic LetoBarone
319 Manatee Drive and East Ravine Drive (813) 470-5954
Ruskin Hillsborough (813) 299-3608
✔ 5/12/2016 @ 8:30 AM
✔ ✔ 2
(2) drums of biodiesel waste that require overpacking and (1) 5-gal bucket of biodiesel waste contaminated soil.
(2) 85
Work clothes✔
Both 55-gals drums need to be overpacked. The contaminated soil is in a 5-gal bucket.
✔ Hazardous waste, liquid, n.o.s. with F003 & Hazardous waste solid, n.o.s. with F003
2,000.00
LE619 37040100000 FL 139900 099001 102577 $2000. 00
Domenic LetoBarone Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2016.05.11 21:38:20 -04'00' 5/11/16
Daniel McAllister Daniel Mcallister Digitally signed by Daniel Mcallister Date: 2016.05.12 08:34:04 -04'00' 5/12/16
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2016.05.12 11:08:56 -04'00' 5/12/16
Austin Hofmeister Austin Hofmeister Digitally signed by Austin Hofmeister Date: 2016.05.13 08:58:27 -04'00'
File details come from the government source that posted it. Updated .