CN-370000-LE705-31-59473.pdf
PDF 288 KB Posted
- Contract number
- LE705
- Issued by
- Florida
About this file
This document is a Work Authorization Form (WAF OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), authorizing work to be performed by PERMA-FIX OF FLORIDA, Inc. under Contract Number LE705. The authorization corresponds to DEP Incident Number 2017-3I-59473, dated December 1, 2017, for a hazardous materials disposal project at the OER South District Hazardous Materials Storage Facility located at 2981 N.E. Pine Island Road, North Fort Myers, Florida (Lee County). The work was requested by Environmental Consultant Lina Cerquera and approved by John S. Johnson, Director of FDEP-OER.
The work involves profiling and transportation of seven drums and containers for disposal, containing materials including 30 gallons of diesel, 55 gallons of resin, 55 gallons of waste petroleum, 20 gallons of mercury, 85 gallons of Kumulus, and 55 gallons of corrosives. The contracted services include use of one supervisor, one truck driver, a straight truck, pickup or van, 20-gallon open-head poly drums, and PPE Level D equipment. The work is authorized as a fixed-price contract with a not-to-exceed amount of $3,000.00, funded through Project Number LE705, Organization Code 37040100000, Object Code 139900, and Fund Category 099001 101492. All required signatures from the DEP Representative, Contractor Representative, and OER Budget Representative were obtained between December 7-8, 2017.
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OER_13 (Effective 7-01-2017)
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
Contract Rate: ____________
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 Not to Exceed estimate amount: $___________________________
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
Amount
Approved:
DEP Representative: __________________________ Signature: _______________________________ Date: __________________
Contractor Rep: __________________________ Signature: ___________________________________ Date: __________________
OER Budget Rep: __________________________ Signature: __________________________________ Date: __________________
Deliverable will be reviewed and evaluated by the DEP Contract Manager to ensure appropriate documentation reviewed and/or provided and that the documentation submitted is complete, accurate, and submitted timely
PERMA-FIX OF FLORIDA, Inc. 2017-3I-59473
LE705 Glenn Byer 12/1/17
OER - SD - HMSF - Bulk Disposal Lina Cerquera
2981 N.E. Pine Island Road 239-344-5707
North Fort Myers, FL 33903 Lee 239-633-5441
Lina Cerquera - 239-344-5707
30 gal. Diesel, 55 gal. Resin, 55 gal. Waste Petroleum, 20 gal. Mercury, 85 gal. Kumulus, 55 gal. Corrosives.
D
Truck Driver 20 gal. Open Head Poly Drum
3,000.00
LE705 37040100000 FC 139900 099001 101492 3,000 00
Lina Cerquera 12/7/17
Glenn S. Byer 12/7/17
Alexa Escobar 12/08/17
John S. Johnson
See Profiles.
Profiling and Transportation of OER - SD - HMSF Containers for Disposal.
Alexa Escobar Paez Digitally signed by Alexa Escobar Paez Date: 2017.12.08 13:26:58 -05'00'
IDVault Digitally signed by IDVault Date: 2017.12.07 16:29:04 -05'00'
Digitally signed by Lina M. Cerquera Date: 2017.12.07 14:13:48 -05'00'
John Johnson Digitally signed by John Johnson Date: 2017.12.07 14:34:11 -05'00'
Cerquera, Lina
From: Johnson, John S.
Sent: Monday, December 4, 2017 3:41 PM To: Cerquera, Lina Cc: Woehle, Melissa; Lara, Jonathan; Escobar, Alexa Subject: Re: Hazardous Materials Drum Disposal
Your approved. I will sign when I get to the office tomorrow.
John Johnson Director
FDEP‐OER
850‐245‐2871
From: Cerquera, Lina Sent: Monday, December 4, 2017 1:01:58 PM To: Johnson, John S.
Cc: Woehle, Melissa Subject: Hazardous Materials Drum Disposal
Good afternoon John, I would like to request approval to hire Perma‐fix for the profiling and disposal of Seven Drums/Containers found in our Hazardous Materials Storage Facility here in Fort Myers. These drums have been accumulated over the past several years (some dating back to when Tim was here) and it is time to do a bulk disposal of them all.
The contractor already looked at the drums/containers and determined the total cost will be approximately $2,670.10.
I’ve attached a WAF for your review and approval.
Thank you, Lina Cerquera Environmental Consultant South District – Office of Emergency Response Florida Department of Environmental Protection Lina.Cerquera@dep.state.fl.us Phone: 239-344-5707
| FDEP South District HMSF Disposal WAF 120117 |
| FDEP South District HMSF Disposal WAF OER Director Approval |
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