CN-370000-LE807-2I-70861.pdf
PDF 162 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 (FDEP), Office of Emergency Response (OER), dated March 2024. The form authorizes work to be performed by ACT (contractor) under Contract LE807 in response to a diesel fuel spill incident (DEP Incident #2024-2I-70861) located at SR-80 @ Birchwood Parkway in LaBelle, Hendry County, Florida. The incident, reported on 2/14/24, involved approximately 65 gallons of diesel fuel and 10 gallons of motor oil. The Incident Commander and OSC (On-Scene Coordinator) is Camren Richter, with authorization signatures from DEP Representative Camren Richter, Contractor Representative Jason Huffman, and OER Budget Representative Vickie Koenig, all dated March 2024.
The authorized work scope includes soil excavation, restoration, and disposal with site screening using a PID/OVA (Photoionization Detector/Organic Vapor Analyzer). The contractor will provide one supervisor, one recovery technician, one field chemist, and one equipment operator, along with specialized equipment including a stakebed truck, two-ton stakebed, rolloff truck with liner, dump truck, PID, 30 cubic yards of backfill, and 36 tons of disposal capacity, plus shoulder closure and sod restoration. The contract is structured as a fixed-price authorization with a not-to-exceed amount of $18,000.00. Funding is allocated under Project LE 807, Organization Code 3704 0100 000, with Object Code 131545 and Fund Category/Year 101492, charged to Account 0990001. All required signatures and digital authorizations were completed by March 8, 2024.
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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
ACT 2024-2I-70861
LE807 2/14/24
SWO 2024--1380 Diesel Fuel Spill Camren Richter
26.764292, -81.384593 SR-80 @ Birchwood Pkwy 561-681-6767
Labelle Hendry 954-658-4506
Approximately 65 gallons of diesel fuel and 10 gallons of motor oil.
1 1
1 Level D
1 - Project Manager, 1 Hand Auger
1-General Scientist, 2-Truck Drivers
1 stakebed Truck, 1 two-ton stakebed, 1 rolloff truck, 1 rolloff box liner, 1 dump truck, 1 PID, 30 yds backfill, 36 tons disposal, 1 shoulder closure, 1 pallet of sod
18,000.00
LE 807 3704 0100 000 FC 131545 0990001 101492 18,000 00
Camren Richter 3/7/2024
Jason Huffman 3-8-24
Vickie Koenig 3/8/2024
Samuel Graves
Soil Excavation/Restoration and Disposal. Screen site with PID/OVA.
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.03.08 09:30:14 -05'00'
Jason Huffman Digitally signed by Jason Huffman Date: 2024.03.08 08:15:35 -05'00'
Camren Richter Digitally signed by Camren Richter Date: 2024.03.07 19:52:03 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.03.08 09:23:27 -05'00'
File details come from the government source that posted it. Updated .