CN-370000-LE619-4I55487.pdf
PDF 226 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 EQ Florida (US Ecology), identified under Contract #LE619, to perform work related to DEP Incident #2016-4I-55487 occurring on 06/07/16 in Lutz, Hillsborough County. The contractor's representative is Daniel McAllister, with Jamie Arleo serving as the On-Scene Coordinator (OSC) for FDEP.
The work assignment involves the transport of drums to a Treatment, Storage, and Disposal Facility (TSDF) for one abandoned drum containing approximately 40-50% gasoline mixed with water in a poly 55-gallon drum. The work is classified as a fixed-price assignment with an estimated amount of $900.00. The scope includes field chemistry services (2 personnel), profiling of the drum waste as D001 and D018 hazardous materials, and analytical and disposal arrangements to be conducted via the contractor. The work is authorized on a reimbursement basis with no OPA-'90 reimbursement potential. Funding is allocated from Project No. LE619, Organization Code 37040100000, Fund 102577, and Object Code 099001, with authorization signatures executed by all required parties on 6/8/16 and 6/9/16.
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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-55487
LE619 Daniel Mcallister 06/07/16
N/A Jamie Arleo
17610 Willow Pond Drive (813) 470-5954
Lutz Hillsborough (813) 267-3651
✔ Pending
✔ 01
(1) poly 55-gal drum of gasoline and water (40% - 50% gasoline)
✔ 2 work clothes✔
Profile drum with D001 and D018. The poly container is in good shape, and does not need to be overpacked.
900.00
LE619 37040100000 FL 139900 102577 099001 $900. 00
Jamie Arleo Arleo_J Digitally signed by Arleo_J Date: 2016.06.08 11:53:40 -04'00' 6/8/16
Daniel McAllister daniel.mcallister@eqonline.com Digitally signed by daniel.mcallister@eqonline.com DN: cn=daniel.mcallister@eqonline.com Date: 2016.06.08 12:06:25 -04'00' 6/8/16
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2016.06.10 12:19:25 -04'00' 6/9/16
Austin Hofmeister Austin Hofmeister Digitally signed by Austin Hofmeister Date: 2016.06.10 12:10:19 -04'00'
File details come from the government source that posted it. Updated .