CN-370000-LE807-4I-71474.pdf
PDF 162 KB Posted
- Contract number
- LE807
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection's Office of Emergency Response and authorizes work to be performed by A-C-T Environmental & Infrastructure Inc under Contract LE807. The authorization is dated August 29, 2024, and pertains to DEP Incident #2024-4I-71474 occurring on August 27, 2024, at the Experimental Farm Road and South Tamiami Trail location in Palmetto, Manatee County. The On-Scene Coordinator is Jon Belcher, and the authorization was approved by DEP Representative Jon Belcher, Contractor Representative Lauren Huffman, and OER Budget Representative Vickie Koenig.
The work involves emergency spill response and abandonment of drums containing approximately 800 gallons of diesel distributed across multiple drums and totes. Services include equipment operation with a vacuum truck and PPE Level D support, with disposal pricing incorporated into the cost estimate covering RCRA empty drums and bulk disposal of petroleum-contaminated waste. The work assignment is structured as a fixed price authorization with a not-to-exceed amount of $3,000, funded through Project LE 807, Organization Code 3704 0100 000, Object Code 131545, and Fund Category 102577. All required signatures were executed on August 29-30, 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
A-C-T Environmental & Infrastructure Inc 2024-4I-71474
LE807 Lauren Huffman 8/27/24
Experimental Farm Rd & S Tamiami Trail Jon Belcher
27.560409, -82.556557 813-470-5908
Palmetto Manatee 813-399-0581
Approximately 800 gallons of diesel between multiple drums and totes.
1 D
Disposal pricing included in cost estimate - 2 RCRA Empty Drums & Bulk Disposal of PCW
3,000
LE 807 3704 0100 000 FC 131545 099001 102577 3,000 00
Jon Belcher 8/29/24
Lauren Huffman 8/29/24
Vickie Koenig 8/29/2024
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.08.29 11:33:16 -04'00'
Lauren Huffman Digitally signed by Lauren Huffman Date: 2024.08.29 09:39:57 -04'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2024.08.29 09:59:16 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.08.30 12:53:18 -04'00'
File details come from the government source that posted it. Updated .