CN-370000-LE680-3I58557.pdf
PDF 240 KB Posted
- Contract number
- LE680
- 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 SWS Environmental Services to perform emergency response work under Contract LE-680. The incident, designated as 2017-3I-58557, occurred on July 27, 2017, at the Collier County Easement location in Naples, Florida. The On-Scene Coordinator (OSC) is Lina Cerquera, with contact information provided for both office and mobile communication.
The authorized work encompasses spill response, abandoned drum removal, soil removal, and waste disposal services related to used oil contamination. The contractor will deploy one supervisor, one recovery technician, and one site foreman using a response truck, stake truck, overpack drums, and three 55-gallon drums for containment. The suspected material is used oil, classified as hazardous waste under this contract. The work is assigned as a cost estimate with an estimated amount of $2,500.00, funded through Project No. LE-680 under Organization Code 37040100000, Object Code 139900, Fund 099001, and Grant Module 101492. OPA-'90 reimbursement is anticipated. The WAF was executed with digital signatures from the DEP Representative (July 28, 2017), Contractor Representative (August 22, 2017), and OER Budget Representative (August 23, 2017).
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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
SWS 2017-3I-58557
LE-680 Eric Cooper 07/27/2017
Collier Co. Easement LM B-01 Canal Abandoned Drums Lina Cerquera
26.077889, -81.735222 (239) 344-5707
Naples Collier (239) 633-5441
✔ ✔ ✔ 7
✔ Waste Disposal
Used Oil
Site Foreman
Work Clothes
Stake Truck, 1ton
✔ Hazardous Waste Used Oil
✔ 2,500.00
LE-680 37040100000 fc 139900 099001 101492 - - 2,500 .00
Lina Cerquera Digitally signed by Lina M. Cerquera Date: 2017.07.28 16:30:35 -04'00' 7/28/17
Eric Cooper Eric Cooper Digitally signed by Eric Cooper DN: cn=Eric Cooper, o=SWS Environmental Services, ou=Service Center Manager, email=ecooper@swses.com, c=US Date: 2017.08.22 11:53:40 -04'00' 8/22/17
Alexa Escobar Alexa Escobar Paez Digitally signed by Alexa Escobar Paez Date: 2017.08.23 13:18:50 -04'00' 8/23/17
John Johnson Digitally signed by John Johnson Date: 2017.08.30 10:03:49 -04'00'
File details come from the government source that posted it. Updated .