CN-370000-LE807-72810Sup.pdf
PDF 178 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 emergency response work to be performed by ACT Integrity Paving under Contract LE807. The incident, designated as DEP Incident #2025-3I-72810, occurred on May 29, 2025, at I-75, MM206 Median in Sarasota County, Florida. The On-Scene Coordinator is H. Hoffmann, with the work site located in Sarasota County.
The work authorization covers spill response and soil removal activities involving coal tar asphalt sealant contamination. The scope of work includes initial response and excavation at a later date, disposal of drums and impacted soil, shoulder closure, fill dirt and sod restoration. The work is assigned as a fixed price contract with a not-to-exceed amount of $2,000.00. The level of effort includes one supervisor, six recovery technicians, and one equipment operator, along with one response truck, pickup or van, backhoe or similar equipment, six 55-gallon drums, and one roll-off container. The contaminated material is profiled and classified as petroleum, non-hazardous. Funding is allocated from Project LE 807 with Object Code 131545, Fund Category 099001, and Budget Code 101492. The Work Authorization Form was approved and executed on September 9, 2025, by all required parties.
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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 2025-3I-72810
LE807 Megan Cross May 29, 2025
Integrity Paving H. Hoffman
I-75, MM206 Median (239) 344-5684
Sarasota Sarasota (239) 872-2323
Coal Tar Asphalt Sealant
6 1
1 D
Includes initial response and excavation at a later date, disposal of drums and impacted soil, shoulder closure, fill dirt and sod to restore
2,000.00
LE 807 3704 0100 000 FC 131545 099001 101492 2,000 00
Heidi Hoffman September 9, 2025
Megan Cross September 9, 2025
Vickie Koenig 9/9/2025
Samuel Graves
✔ Petroleum, non-hazardous
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.09.09 16:06:15 -04'00'
Megan Cross Digitally signed by Megan Cross Date: 2025.09.09 10:46:43 -04'00'
Heidi Hoffman Digitally signed by Heidi Hoffman Date: 2025.09.09 10:27:48 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.09.10 08:48:45 -04'00'
File details come from the government source that posted it. Updated .