CN-370000-LE807-4I66243C.pdf
PDF 131 KB Posted
- Contract number
- LE807
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection's Office of Emergency Response. The document authorizes ACT (contractor) to perform emergency response work under Contract LE807. The incident, designated as DEP Incident #2022-4I-66243C, occurred on 01/04/2023 at Manual St. and Tablerock Dr. in Webster, Hernando County, Florida. The work was authorized by DEP Representative Melissa Woehle, with Jason Huffman serving as the Contractor Representative and Tameshia Reid as the OER Budget Representative. Jonathan Belcher served as the On-Scene Coordinator.
The work authorization encompasses spill response, soil removal, sampling, and complete site clean-up and disposal related to a Rim-Strip dumping incident involving a hydrofluooric acid mixture with an estimated quantity of 15 or more units. The scope includes response and stabilization of the incident, assessment of impacted areas, management and removal/staging of waste and impacted soil and groundwater, and arrangement for proper disposal. The authorization specifies a cost-plus arrangement with a not-to-exceed estimate amount of $201,650. Personnel authorized include supervisors, recovery technicians, field chemists, and equipment operators. Equipment includes response trucks, straight trucks, vacuum trucks, overpack drums, roll-off containers (15 or more), sampling gear (EPA Levels 1 and 2), and a frac tank. Funding is allocated from Project LE807, Organization Code 450202000, with an Object Code of 131545 and Fund Category 088502/YR23. The partial invoice for work to complete source removal, initial disposal, sampling/analysis, and staging was approved on 1/30/2024.
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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
ACT 2022-4I-66243C (corrected - MW)
LE807 Ashley Shive 01/04/2023
Rim-Strip Dumping *Criminal Case* Jonathan Belcher
Manual St. adn Tablerock Dr. 813-470-2023
Webster Hernando 813-399-0581 work completed - MW used Rim-Strip (hydrofluooric acid mixture)
15 + as needed
Project Manager frac tank
& cost plus - MW
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.
201,650
LE807 450202000 AD 131545 000286 088502/YR23 201,650 00
Melissa Woehle 1/22/2024
Jason Huffman 1-22-2024
Tameshia Reid 1/30/2024 complete site clean-up and disposal
✔ 26
Tameshia N. Reid Digitally signed by Tameshia N. Reid Date: 2024.01.30 10:12:42 -05'00'
Jason Huffman Digitally signed by Jason Huffman Date: 2024.01.22 12:55:02 -05'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2024.01.22 11:16:54 -05'00'
Justin M. Davis Digitally signed by Justin M. Davis Date: 2024.01.30 14:50:48 -05'00'
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