CN-370000-LE681-4I-62836.pdf

This is a Work Authorization Form issued by the Florida Department of Environmental Protection, Office of Emergency Response, for emergency response services. The contractor is ACT, represented by Jason Huffman, with the work site located in Polk City, Polk County, Florida. The incident is DEP Incident #2019-4-62836, dated April 12, 2019, with Jeff Tobergte designated as the On-Scene Coordinator.

The work authorization covers spill response and soil removal services related to a motor oil leak from an overturned log truck. The contractor is authorized to respond immediately and transport drums to the Florida Department of Environmental Protection Facility (TSDF). The level of effort includes one supervisor and two recovery technicians, utilizing a response truck, pickup van, and equipment including a 55-gallon drum (quantity 3), work clothes, and other items such as a drain pump, generator, and compressor. The analytical and disposal arrangements specify that waste will be profiled and disposed of via contractor, with oily pads, soil, and absorbents designated as the waste type. The work assignment is fixed price with a not-to-exceed estimate amount of $5,000.00, funded under Project No. LE681, Organization Code 3704010000, with funding charged to Fund 099001, Category/Year 101492. The authorization was approved on April 15, 2019, with signatures from the DEP Representative and Contractor Representative.