CN-370000-LE619-4i55354.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 (FDEP), Office of Emergency Response. The document authorizes emergency response work for incident 2016-4i-55354 dated May 18, 2016. The contractor is EQ Florida, operating under Contract LE619, with Daniel McAllister serving as the representative. The work site is located at three spots along Old US 41 in Riverview, Hillsborough County, Florida. The On-Scene Coordinator (OSC) is Jeff Tobergte, with office phone (813) 470-5954 and cell phone (813) 267-3521.
The work authorization covers removal and containment of hazardous materials, specifically 2 fifteen-gallon drums of used oil, 4 one-gallon jugs of used oil, and 8 five-gallon pails of paints and water. The scope includes scraping and shoveling contaminated soil into drums, consolidating oils into a single 30-gallon drum, and transporting drums to a Treatment, Storage, and Disposal Facility (TSDF). The work is assigned as a fixed-price contract with an estimated cost of $1,600.00. One supervisor and two recovery technicians are allocated, with equipment including a response truck, four 55-gallon drums, PPE Level D, and a 30-gallon drum. The suspected materials are profiled as D006, D007, D008, D018, F002, F003, F005 (oils and soil), and D001 (paints). Funding is provided through Project LE619, Organization Code 37040100000, Fund 099001, with Grant 102577. The work was scheduled for Thursday afternoon, May 19, 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 2016-4i-55354
LE619 Daniel McAllister 5/18/16
Drums and pails Jeff Tobergte
3 spots along Old US 41 (813) 470-5954
Riverview Hillsborough (813) 267-3521
✔ for Thursday afternoon 5/19.
2 x 15-gal drums used oil, 4 x 1-gal jugs used oil, 8 x 5-gal pails paints/water. Scrape/shovel soil into 2 drums, plus contaminated oily pads. Pour oils into a single 30-gal. drum (the poly drums are only partly full).
✔ 2
D hand shovels, manifest, LDR, labels
✔ 1 x 30-gal OH drum
✔ oils, and soil: D006, D007, D008, D018, F002, F003, F005. Paints: D001.
1,600.00
LE619 37040100000 FL 139900 099001 102577 $1600. 00
Jeff Tobergte Tobergte_J Digitally signed by Tobergte_J Date: 2016.05.19 08:35:55 -04'00' 5/18/16
Daniel McAllister daniel.mcallister@eqonline.com Digitally signed by daniel.mcallister@eqonline.com DN: cn=daniel.mcallister@eqonline.com Date: 2016.05.19 08:47:41 -04'00' 5/19/16
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2016.05.20 08:18:10 -04'00' 5/20/16
John Johnson, email John Johnson Digitally signed by John Johnson Date: 2016.05.19 10:36:48 -04'00'
File details come from the government source that posted it. Updated .