CN-370000-LE706-4I68510.pdf
PDF 132 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 authorizes emergency response work performed by Cliff Berry, Inc. under Contract #706 for incident 2021-4I-68510 occurring on December 15, 2021. The incident involved abandoned drums located at Williams Road and E Sligh Avenue in Seffner, Hillsborough County, Florida. Key personnel involved include Trevor Wavelet (On-Scene Coordinator), Nicole Collins (DEP Representative), Jon Sandora (Contractor Representative), and Amanda Lanphere (OER Budget Representative).
The work involved emergency response to illegal abandonment and dumping of three 55-gallon drums containing used motor oil and suspected paint materials. Services authorized included spill response activities, transportation of drums to a treatment storage and disposal facility (TSDF), and containment measures such as uprighting drums and placing garbage bags with caution tape around them. The authorization specifies deployment of one supervisor, one recovery technician, and one equipment operator, along with a pickup/van vehicle, visqueen material, three 55-gallon drums, and work clothes as personal protective equipment. The work was assigned as a fixed price contract with a not-to-exceed estimate amount of $2,000. Funding was allocated through Project No. LE 706, Organization Code 37040100000, with the cost charged to Object Code 139900 and Fund Category 099001 in fiscal year 102577. All required approvals and digital signatures were obtained on or before December 21, 2021.
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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
Cliff Berry, Inc 2021-4I-68510
706 Nicole Collins December 15, 2021
Williams rd & E Sligh Ave Abandoned Drums Trevor Wavelet
Williams rd & E Sligh Ave (813) 470-5946
Seffner Hillsborough (813) 399-0581
3 55 gallon drums of used motor oil & suspected paints
1 Work Clothes
Illegal abandonment & dumping of 3 55 gallon drums
$2000
LE 706 37040100000 FC 139900 099001 102577 2000 00
Trevor Wavelet December 16, 2021
Jon Sandora December 21, 2021
Amanda Lanphere December 21, 2021
Samuel Graves
Petroleum and suspected paint
Uprighted drum to stop discharge. Garbage bag placed over each drum and caution tape around the perimeter of the area of concern
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2021.12.21 16:52:35 -05'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2021.12.21 14:07:42 -05'00'
Trevor Wavelet Digitally signed by Trevor Wavelet Date: 2021.12.16 13:39:19 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2021.12.21 14:37:11 -05'00'
File details come from the government source that posted it. Updated .