CN-370000-LE706-4I-68979.pdf
PDF 129 KB Posted
- Contract number
- LE706
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection (DEP), Office of Emergency Response (OER). The document authorizes work under Contract LE706 with contractor CBI in response to DEP Incident #2022-4I-68979 dated May 3, 2022. The incident occurred at Stotz Road in Palmetto, Manatee County, Florida, with On-Scene Coordinator Domenic LetoBarone overseeing the response activities.
The work authorization authorizes removal of soil contamination and transport of drums to a Treatment Storage and Disposal Facility (TSDF), with an estimated cost of $1,000.00. The suspected materials consist of used oil and transmission fluid to be poured into 55-gallon drums or over-pack buckets, along with shovel soil placed into 14 empty 5-gallon buckets. The level of effort includes one supervisor, one field chemist, one response truck, two 55-gallon drums, and PPE Level D equipment. Analytical and disposal arrangements are handled via the contractor, with waste profiled as used oil. The work is assigned as fixed-price with a not-to-exceed estimate of $1,000.00. Funding is provided through Project LE706, Organization Code 37040100000, Object Code 139900, Fund 099001, and Category/Year 101492. The authorization was approved by DEP Representative Domenic LetoBarone, Contractor Representative Jon Sandora, and OER Budget Representative Amanda Lanphere on May 3-4, 2022.
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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 2022-4I-68979
LE706 Jon Sandora 5/3/2022
Domenic LetoBarone
Stotz Rd. N27* 35.0520 / W-82* 35.1720 813-470-5735
Palmetto Manatee 813-625-7636
Please call 1 hour before to allow for travel time
Used oil and transmission fluid / pour into 55-gallon drums or over-pack buckets / Shovel soil into empty 5-gallon buckets
D
Please advise if you would like to pour the contents of the oil into two 55-gallon drums or over-pack the buckets.
1,000.00
LE706 37040100000 FC 139900 099001 101492 1,000 00
Domenic LetoBarone 5/3/2022
Jon Sandora 05/04/2022
Amanda Lanphere 05/04/2022
S. Graves - phone 5.3.22
Used oil
Law Enforcement advised that there is a minor amount of impacted soil
✔ 14 x 5-gal
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.05.04 15:56:16 -04'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2022.05.04 13:31:35 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2022.05.03 13:45:49 -04'00'
File details come from the government source that posted it. Updated .