CN-370000-LE807-2I-69406.pdf
PDF 131 KB Posted
- Contract number
- LE807
- 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 document authorizes American Compliance Technologies to perform emergency response work related to incident 2022-6288-CLR at a location in Miami, Miami-Dade County, Florida. The incident occurred on August 18, 2022, and the Incident Commander was Camren Richter.
The scope of work involves spill response services for approximately 100 gallons of diesel fuel spilled from a tractor-trailer saddle tank following a truck fire. The contractor's tasks include removing and drumming diesel-impacted absorbents, cleaning remaining diesel fuel from the roadside, and using a drum vacuum to clean the storm drain if necessary. The work assignment is designated as a fixed price contract with a not-to-exceed amount of $6,000.00. The authorized level of effort includes one supervisor and two technicians, one response truck, and five 55-gallon drums. Analytical and disposal arrangements are to be handled via the contractor. Funding is allocated from project LE807, organization code 37040100000, with object code 139900, fund category 099001, and funding year 12577. All required signatures were obtained between August 18 and August 30, 2022, from the contractor representative, DEP representative, and OER budget representative.
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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
American Compliance Techologies 2022-6288 CLR 2022-2I-69406
LE807 8/18/22
Miami FL Camren Richter
NW 27th Ave & NW 35th St.
Miami Miami Dade 954-658-4506
2 Techs
Remove & drum up diesel impacted absorbents. Clean any remaining diesel fuel on side of road. If needed usedrum vacuum to cleanout the storm drain.
Approximately 100 gallons spilled from Tractor Trailer saddle tank from truck fire.
6000.00
LE807 37040100000 FL 139900 099001 12577 6000 00
Camren Richter 8./18/22
Lauren Johnson 8/25/22
Amanda Lanphere 08/30/2022
Samuel Graves
✔ 5
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.08.30 15:50:59 -04'00'
Lauren Johnson Digitally signed by Lauren Johnson Date: 2022.08.25 10:12:50 -04'00'
Camren Richter Digitally signed by Camren Richter Date: 2022.08.18 13:49:15 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.08.30 13:28:02 -04'00'
Richter_C Cross-Out
Richter_C Cross-Out
File details come from the government source that posted it. Updated .