CN-370000-LE807-3I-66942.pdf
PDF 129 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 work to be performed by ACT (contractor) under Contract LE807 in response to a diesel spill incident (DEP Incident #2021-3I-66942) that occurred on January 28, 2021, at Interstate 75 Milemarker 139 SB in Lee County, Fort Myers. The incident was reported to and overseen by Lina Ramirez, the On-Scene Coordinator, with Jason Huffman serving as the contractor's representative.
The work authorization covers spill response and soil removal activities, including backfill, sod installation, OVA (organic vapor analysis), disposal, shoulder closure, and closure sampling services. The contractor will utilize three truck drivers for excavation, one truck driver for disposal operations, and equipment including two rolloff trucks, one semi truck with flatbed, one stakebed truck, and an excavator. The scope addresses approximately 20-30 gallons of diesel-contaminated soil. The work is assigned as a fixed-price contract with a not-to-exceed estimate of $16,500. Funding is allocated from Project LE807 under Organization Code 37040100000, Object Code 139900, Fund Category 099001, with cost center 101492. The authorization was executed on February 24, 2021, with final approval signatures completed by February 25, 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
Response Truck Overpack Drums: Visqueen
Straight Truck 55-gal. Drums: Roll-off Containers: ___________
Vacuum Truck Sampling Gear EPA Level 1 Vapor Detector
Pickup or Van Sampling Gear EPA Level 2 PPE Level: __________________
Supervisor: ____
Recovery Tech: ____
Gen. Scientist : ____
Equip. Oper.: ____
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 2021-3I-66942
LE807 Jason Huffman 1/28/2021
I75 Milemarker 139 SB Lina Ramirez
I75 Milemarker 139 SB 239.344.5623
Fort Myers Lee 239.770.7418
Diesel, 20-30 gallons work clothes (5)
Truck Driver (3)
3 truck drivers for day of excavation, 1 truck driver for day of disposal
2 rolloff trucks, 1 semi truck with flatbed, 1 stakebed, excavator
$16,500
LE807 37040100000 FC 139900 099001 101492 16500
Lina Ramirez
Jason Huffman 2-24-21
Kristin Gousse 2-25-2021
Cory Dewayne Dilmore
Diesel contaminated soil
Backfill, Sod, OVA, Disposal, Shoulder Closure, Closure samples
Kristin Gousse Digitally signed by Kristin Gousse Date: 2021.02.25 11:58:17 -05'00'
Jason Huffman Digitally signed by Jason Huffman DN: cn=Jason Huffman gn=Jason Huffman c=United States l=US o=ACT ou=Emergency Response e=jhuffman@act.com Reason: I have reviewed this document Location:
Date: 2021-02-24 13:30-05:00
Lina Ramirez Digitally signed by Lina Ramirez Date: 2021.02.24 13:46:58 -05'00'
Cory Dewayne Dilmore Digitally signed by Cory Dewayne Dilmore Date: 2021.02.24 13:50:26 -05'00'
File details come from the government source that posted it. Updated .