CN-370000-LE706-4I65598C.pdf
PDF 616 KB Posted
- Contract number
- LE706
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, Effective 7-01-2017) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER). The form authorizes work to be performed by CBI, Inc. under Contract LE706 for incident 2020-4I-65598C occurring on 4/22/2020 at a 1 x 55-gallon drum site located on County R.O.W on Towaway Road in Tampa, Hillsborough County. The Incident Site Coordinator is Domenic LetoBaone, and the contractor representative is Jon Sandora.
The work scope includes removal of an illegally dumped drum of waste gasoline and used oil from County R.O.W, with transportation to both a Treatment, Storage, and Disposal Facility (TSDF) and a Temporary Storage Area (TSA). The authorization calls for one supervisor and one recovery technician, utilizing a response truck, with PPE Level D equipment specified. The work is authorized as a fixed-price assignment with a not-to-exceed estimate of $1,475.00, with analytical and disposal to be handled via the contractor. Funding is sourced from Project LE706, Organization Code 37040100000, Object Code 139900, Fund 212001, Category/Year 104132, with the total authorization amount of $1,475.00. The work authorization was approved and signed by FDEP Representative Domenic LetoBaone, Contractor Representative Jon Sandora, and OER Budget Representative Kristin Gousse on 4/23/2020 and 5/4/2020.
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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
File details come from the government source that posted it. Updated .