CN-370000-LE706-4I56106.pdf
PDF 227 KB Posted
- Contract number
- LE706
- Issued by
- Florida
About this file
This is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response. The document authorizes emergency response work performed by Cliff Berry, Inc. under Contract LE706 for Incident 2016-4i-56106. The incident occurred on August 15, 2016, in Tampa, Hillsborough County, Florida, with Jeff Tobergte serving as the On-Scene Coordinator. The work was performed across from 5110 14 Avenue North in Tampa and involved response to an abandoned drum containing waste lacquer thinner.
The work scope included immediate response procedures, overpack drums, transport of drums to a temporary storage area, removal of contaminated soil, and sampling. The contractor deployed one supervisor, one recovery technician, and one response truck to address the spill of one 55-gallon drum that was approximately half full and had leaked onto soil. The contractor hand-shoveled the contaminated soil and used five feet of absorbent boom with six bails for containment. The work assignment was designated as a fixed-price contract with an estimated amount of $3,000.00. Analytical and disposal arrangements were pending analysis through the contractor and subcontractor. Funding was provided through Project LE706, Organization Code 37040100000, Fund 099001, Category/Year 102577. The work was completed on August 15, 2016, with the WAF executed after-the-fact via verbal and email approval, with final approvals signed on August 16, 22, and 23, 2016.
View the file
Other files
Show 40 more
50 files listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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
Other: ____________ Other: ____________ Other:______________________
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 cost estimate est’d amount: $____________________________
Reimbursement Potential: no yes OPA-’90 reimbursement Resp. Party Reimbursement
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
Module/ OCA Grant Amount
Approved:
DEP Representative: __________________________ Signature: _______________________________ Date: __________________
Contractor Rep: __________________________ Signature: ___________________________________ Date: __________________
OER Budget Rep: __________________________ Signature: __________________________________ Date: __________________ OER_13 (Effective 9-14-2015)
Prior Approval received by printed name: Signature
Cliff Berry, Inc. 2016-4i-56106
LE706 Jon Sandora 8/15/16
Tampa lacquer thinner drum Jeff Tobergte across from 5110 14 Ave N (813) 470-5954
Tampa Hillsborough (813) 267-3521
✔ ✔ ✔ 1
1 x 55-gal drum, 1/2 full of waste lacquer thinner, leaked onto soil to be hand-shoveled.
[NOTE: job was done on 8/15, via verbal/email approval. This WAF was done after-the-fact.]
✔ work clothes/Level C✔
5 foot absorbent boom x 6 Bails
✔ ✔ ✔ Disposal pending analytical.
3,000.00
LE706 37040100000 FL 139900 099001 102577 $3000. 00
Jeff Tobergte Tobergte_J Digitally signed by Tobergte_J Date: 2016.08.16 13:28:21 -04'00' 8/16/16
Jon Sandora Jon Sandora Digitally signed by Jon Sandora DN: cn=Jon Sandora, o, ou, email=jsandora@cliffberryinc.com, c=US Date: 2016.08.22 11:35:29 -04'00' 8/22/16
Amanda Hartsfield Amanda Hartsfield Digitally signed by Amanda Hartsfield Date: 2016.08.23 09:02:03 -04'00' 8/23/16
John Johnson John Johnson Digitally signed by John Johnson Date: 2016.08.22 08:45:00 -04'00'
File details come from the government source that posted it. Updated .