CN-370000-LE706-4C-65279.pdf
PDF 132 KB Posted
- Contract number
- LE706
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection, Office of Emergency Response. The document authorizes work to be performed by Cliff Berry, Inc. under Contract #LE706 in response to DEP Incident #2020-4C-65279. The incident, dated March 4, 2020, involved abandoned drums at Honeymoon Island State Park in Dunedin, Pinellas County. The primary contact for the Department is Domenic LetoBarone, with Jon Sandora serving as the contractor representative.
The work authorization specifies the removal and proper disposal of three 55-gallon drums containing vegetable oil, used oil/water mixture, and diesel fuel located at the state park maintenance area. The contractor is authorized to vacuum out all three drums, transport them to a treatment storage and disposal facility (TSDF), and provide manifest documentation and appropriate personal protective equipment. The work is assigned as a fixed-price task with a not-to-exceed estimate of $2,000.00. Funding is allocated from Project LE706 using Organization Code 37040100000, Object Code 139900, and Fund Category 099001-101492. The authorization was approved on March 6, 2020, by the DEP Representative, Contractor Representative, and OER Budget Representative, with final review completed by March 9, 2020.
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Text version
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
Cliff Berry, Inc. 2020-4C-65279
LE706 Jon Sandora 3/4/2020
Honeymoon Island - drums Domenic LetoBarone
1 Causeway Blvd. - inside the State Park Maintenance Area 813-470-5920
Dunedin Pinellas 813-299-3608
Please call cell to schedule at date - Tues - Friday works
1 x 55-gal. drum Vegetable Oil (full), 1 x 55-gal. drum used oil / water mixture (full), 1 x 15-gal. drum diesel fuel (full)
1 Level D
Manifest / paperwork
All 3 drums are located at the Honeymoon Island State Park maintenance area. The vegetable oil drum can not be sealed, the bung thread has disintegrated.
Best approach is to vacuum out all three drums using a vacuum truck.
2,000.00
LE706 37040100000 FC 139900 099001 101492 2,000
Domenic LetoBarone 3/6/2020
Jon Sandora - CBI, Inc. 3/6/2020
Kristin Gousse 3/9/2020
Melissa Woehle - 3/6/2020
Used Oil/Water mix, Vegetable Oil, Diesel fuel
Vacuum out all three drums, bring manifest / labels / PPE - gloves
✔ 3
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.03.09 09:21:43 -04'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2020.03.06 12:56:09 -05'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2020.03.06 11:32:29 -05'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.03.06 14:24:51 -05'00'
File details come from the government source that posted it. Updated .