CN-370000-LE706-4I-69047.pdf
PDF 128 KB Posted
- Contract number
- LE706
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13, effective July 1, 2017) is issued by the Florida Department of Environmental Protection (FDEP) Office of Emergency Response. The document authorizes CBI as the contractor for emergency response services related to incident number 2022-4I-69047 in Hudson, Pasco County, Florida. The incident occurred on May 19, 2022, and involved an abandoned drum located at 6627 Beach Boulevard. Jordan Luscier served as the On-Scene Coordinator, with Jon Sandora representing the contractor and Jordan Luscier representing FDEP.
The work scope involves the recovery and proper handling of one 55-gallon drum containing Micro Matic Beer Line Cleaner that was discovered in the water. The authorization requires contractor-supplied personnel (supervisor and recovery technician) and equipment including a response truck and overpack drums to safely remove and transport the drum. The analytical and disposal arrangements were to be coordinated via the contractor. The work assignment is designated as a fixed-price authorization with a not-to-exceed estimate amount of $3,000. Funding was allocated from project LE706 under organization code 37040100000, with the cost recorded to object code 139900 in fund category 102577. All required signatures from FDEP Representative Jordan Luscier, Contractor Representative Jon Sandora, and OER Budget Representative Amanda Lanphere were obtained on May 19-20, 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-69047
LE706 Jon Sandora 5/19/22
Hudson Abandoned Drum Jordan Luscier
6627 Beach Blvd 813-267-3521
Hudson Pasco 813-267-3521
Micro Matic Beer Line Cleaner
Work Clothes
Gear needed to get the drum out of the water will be necessary.
3,000
LE706 37040100000 FC 139900 099001 102577 3000 00
Jordan Luscier 5/20/22
Jon Sandora 5/20/22
Amanda Lanphere 5/20/2022
Samuel Graves
(1) 55-Gallon Drum
✔ ✔ 1
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.05.20 09:03:35 -04'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2022.05.20 08:00:38 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.05.20 08:34:00 -04'00'
Jordan Luscier 5/19/22
File details come from the government source that posted it. Updated .