CN-370000-LE807-4I-66243.pdf
PDF 273 KB Posted
- Contract number
- LE807
- Issued by
- Florida
About this file
This Work Authorization Form (WAF OER_13) is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response, for emergency response services provided by ACT under Contract #LE807. The authorization is tied to DEP Incident #2023-41-68243C dated January 4, 2023, at the Rim-Strip Dumping site located at Manuel Street and Tablerock Drive in Webster, Hernando County, Florida. The work is managed under the direction of On-Scene Coordinator Jonathan Belcher.
The scope of work authorizes ACT to respond immediately to a chemical spill involving used Rim-Strip containing methylene chloride, phenol, hydrofluoric acid, and formic acid. Services include spill response, removal of impacted soil, sampling, transport of 26 abandoned drums to a Treatment, Storage, and Disposal Facility (TSDF), and related environmental assessment and remediation activities. The authorization employs multiple personnel classifications (supervisor, recovery technician, field chemist, equipment operator, and project manager), vehicles (response truck, straight truck, vacuum truck, pickup/van, and backhoe), and specialized equipment (overpack drums, 55-gallon drums, roll-off containers, visqueen, vapor detector, and frac tank). The work is assigned on a fixed-price basis with a not-to-exceed estimate of $250,000, funded through Project LE807, Organization Code 450202000, Object Code 131545, Fund 000286, Category/Year 088502. The authorization was executed on April 5, 2023, with supplemental work authorization anticipated for final site cleanup and disposal activities.
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Text version
Florida Department of Environmental Protection
Office of Emergency Response
WORK AUTHORIZATION FORM
Required Signatures: Adobe Signature or Original In!{
Contractor: ACT
D Supplemental W AF
Con tract #: LE807 Rep: _A_s _hl_ey_S_ h_iv_e _ _ _ _ _ _ Site Name: Rim-Strip Dumpin g *C r imi nal Case*
Location: Manu el St. and Table rock Dr .
City: Webster County: _H_ e_rn_a_nd_o _____ _
Description of Work: Respond Immediately
[Z] Spill Response D Overpack Drums
DEP Incident # _2 _02_3_-4_1-a_s_24_3_c _____ _ Incident Date _0_1,_04_12_ 0_2 _3 ______ _ OSC: Jonathan Belcher
Phone: Office._8 _13_-4_7_o-_59_ o_s _____ _ Cell 813-399-0581
Call OSC to set date/time on-goin g (coordinate with OSC)
D Transport drums to TSA l ✓ I Abandoned Drum: 26
[Z] Remove Soil I ✓ I Sampling I✓ l Transport Drums to TSDF □ Analysis of samples collected by OER
Other:
Suspected Materials, and amounts: used Rim-Strip (met hylene c hlor id e, phe nol, hydrofluoric acid , formic acid)
Level of Effort: (Check all that apply)
Personnel
[Z] Supervisor: __
[Z] Recovery Tech: __ l ✓ l Field Chemist: _ _ l ✓ l Equip. Oper.: _ l ✓ ! Other: Projec t Manager
Vehicles
0 Response Truck
0 Straight Truck
[l] Vacuum Truck
[Z] Pickup or Van
[Z] Backhoe or Similar
[ZJ Contract Rate:
Use Subcontractor per OSC
Equipment
[l] Overpack Drums: l ✓ l Visqueen
[Z] 55-gal. Drums: l✓l Roll-offContainers:
□ Sampling Gear EPA Level 1 I ✓ I Vapor Detector
Sampling Gear EPA Level 2 j ✓ I PPE Level:
Other: Frac Tank/ □ MOT
Comments: ACT was verbally authorized to respond and stabilize the Incident; assess the Impacted areas; manage and remove/stage waste, impacted soil, and groundwater;and arrange for proper disposal.
Supplemental work authorization may be required to complete site clean-up and disposal. Partial invoice approved for work to complete source removal, initial disposal sampling/analysis and staging.
Analytical & Disposal Arrangements: (analytical will usually be listed on Chain-of-Custody or other form)
[Z] Via Contractor D Via Subcontractor Other:
□ Profile Wastes as: pending sample analysis
Work Assignment Type: fixed price D Not to Exceed estimate amount: $ 250,000
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 Obiect Code Fund
Approved:
M I• W h I Digitally signed by Melissa Woehle
DEP Representative: _M_ e_lis_ s_a _w_o_eh_le __ _ _ _ __ Signature: e 1ssa oe e 0.,.,202,.02.1011,oo,11-os'OO'
Contractor Rep: t1::b'°1Sbt \\e.,. Signature: Q.tJ, � � OER Budget Rep: Signature: ____________ _ _ _
Cate1mrv/Yr Amount
I
Date: 0211012023
Date: 01�,�� 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
OER_13 (Effective 7-01-2017)
Amanda Lanphere 04/05/2023
450202000LE807 AD 131545 000286 088502 $250,000 00
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.04.05 11:16:46 -04'00'
Jessica Kramer Digitally signed by Jessica Kramer Date: 2023.04.24 09:41:48 -04'00'
File details come from the government source that posted it. Updated .