CN-370000-LE807-4I-68142.pdf
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- Contract number
- LE807
- Issued by
- Florida
About this file
Work Authorization Summary
This is a Work Authorization Form (OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection's Office of Emergency Response. The document authorizes emergency response work under Contract LE807 with ACT (contractor), with involvement from DEP representatives Trevor Wavelet (On-Scene Coordinator) and MaryAlice McElheney (approver). The incident occurred on August 31, 2021, at 10600 Moore Road in Lakeland, Polk County, Florida, and was assigned DEP Incident #2021-4I-68142.
The work authorization covers immediate spill response and soil removal services following a petroleum release involving approximately 80-100 gallons of used oil. The scope includes deployment of a vacuum truck, absorbent pads, and absorbent boom to address contaminated soils and oily water. The Level of Effort includes 1 Supervisor, 4 Recovery Technicians, and 2 Equipment Operators, along with specified vehicles (response truck, vacuum truck, pickup/van, and backhoe) and equipment (overpack drums, roll-off containers, and PPE). The work is assigned as a fixed-price task with a not-to-exceed amount of $35,000. Analytical and disposal arrangements are handled via the contractor and profiled as used oil-contaminated materials. Funding is allocated under Project LE807, Organization Code 37040100000, Object Code 139900, with $35,000 distributed across funding categories. All required signatures were executed between August 31 and September 7, 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
ACT 2021-4I-68142
LE807 Jason Huffman 8/31/21
Moore Rd Oil Releases Trevor Wavelet
10600 Moore Rd (813)-470-5946
Lakeland Polk (813)-399-0581
Petroleum, ~80-100 gallons
4 3
2 Work Clothes
55 gallon drum of used oil spilled in ditch on county R.O.W. and subsequent oil release 1 mile down the road.
35,000
LE807 37040100000 FC 139900 099001 101492/00 35000 00
Trevor Wavelet 8/31/21
ACT 8-31-21
Precious Boatwright
MaryAlice McElheney
Used oil contaminated soils and oily water
Vacuum truck, deployed pads and absorbent boom
Precious Boatwright Digitally signed by Precious Boatwright Date: 2021.09.01 09:45:11 -04'00'
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: 2021-08-31 17:13-04:00
Trevor Wavelet Digitally signed by Trevor Wavelet Date: 2021.08.31 16:02:42 -04'00'
Mary Alice McElheney Digitally signed by Mary Alice McElheney Date: 2021.09.07 13:39:31 -04'00'
File details come from the government source that posted it. Updated .