CN-370000-LE706-4I-65453.pdf
PDF 131 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's Office of Emergency Response. The form documents authorization for emergency response services provided by CBI, Inc. under Contract #LE706. The incident involved response to an illegal dumping incident at a right-of-way location across from 8610 East Sligh Avenue in Tampa, Hillsborough County, Florida. The On-Scene Coordinator (OSC) was Domenic LetoBarone, with Jon Sandora serving as the DEP representative.
The work authorization authorized CBI, Inc. to transport approximately 70 illegally dumped 1.5-gallon containers of used oil that had been consolidated into 2 55-gallon drums, along with an additional drum of spent absorbent material, soil, and PPE, and 3 85-gallon contractor bags containing empty containers to CBI's facility in Tampa. The work assignment was designated as fixed price with a not-to-exceed estimate amount of $300.00, which consisted of a $200.00 drop-off fee. Funding was allocated from Project LE706, Organization Code 37010400000, with Object Code 139900, Fund 212001, and Category/Year 104132. The authorization was executed on March 25, 2020, with digital signatures from all required parties including the DEP Representative, Contractor Representative, and OER Budget Representative.
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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
CBI, Inc. 2020-4I-65453
LE706 Jon Sandora 3-20-2020
Sligh Avenue used oil dumping Domenic LetoBarone
R.O.W. across from 8610 East Sligh Avenue 813-470-5920
Tampa Hillsborough 813-299-3608
OER will transport to CBI
~ 70 x 1.5-gallon containers of used oil were illegally dumped on County Right-of-Way. OER poured oil off into 55-gal. drums
Drop-off fee $200
OER poured off the used oil containers into 2 x 55-gallon drums. An additional drum of spent absorbent , soil, and PPE was also generated.
The empty containers were placed into 3 x 85-gallon contractor bags for disposal via CBI.
300.00
LE706 37010400000 JC 139900 212001 104132 300
Domenic LetoBarone 3/25/2020
Jon Sandora 3/25/2020
Kristin Gousse 3/25/2020
Melissa Woehle 3/24/20
✔ 5
OER will transport 2 x 55-gallon drums and empty containers to CBI in Tampa
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.03.25 13:49:40 -04'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2020.03.25 09:35:51 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2020.03.25 08:53:13 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.03.25 13:34:25 -04'00'
File details come from the government source that posted it. Updated .