CN-370000-LE807-8C-71562.pdf
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- Contract number
- BS136
- Issued by
- Florida
About this file
Work Authorization Form Summary
This Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection (FDEP) Office of Emergency Response authorizes emergency response services to be provided by American Compliance Technologies under Contract #LE807. The work is assigned to Incident #2024-8C-71562 occurring on September 26, 2024, at Keaton Beach Bum, located at 20051 Beach Road in Keaton Beach, Taylor County, Florida. Key personnel involved include Ashley Shive (contractor representative), Travis Burch (On-Scene Coordinator), and representatives from FDEP including Gracie Brinson, Vickie Koenig, and Samuel Graves.
The work scope involves the immediate response to a spill containing approximately 10,000 gallons of a gasoline and diesel fuel mixture, requiring the removal of remaining fuel from a tank using the safest method, containment, and absorption of spilled fuel. The contractor will provide one supervisor, two recovery technicians, and two equipment operators, along with necessary vehicles (vacuum truck, pickup/van, and backhoe or similar equipment), equipment (visqueen, 55-gallon drums, roll-off containers, and PPE Level D), and miscellaneous items including a semi-truck for heavy equipment, lodging and meals at state travel rates, and port-a-potty rental. The work is authorized as a fixed price contract with a not-to-exceed estimate of $35,000, funded through Project Number LE807 with Organization Code 3704 0100 000, Fund Category 101492, and Object Code 131545. All required signatures were obtained between September 24 and September 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
American Compliance Technologies 2024-8C-71562
LE807 Ashley Shive 9/26/24
Keaton Beach Bum Travis Burch
20051 Beach Road, Keaton Beach
Perry Taylor 321-388-6371
9/28/24 @ 1100
10,000 gals of a mixture of gasoline and diesel
2 pending size of excavation
2 Level D
Project Manager Vacuum truck hoses, waders
Semi truck for heavy equipment, possibility of lodging and meals at state travel rates and port-a-potty rental. Miscellaneous cleanup items.
35,000
LE807 3704 0100 000 FC 131545 099001 101492 35,000 00
Gracie Brinson 9/24/24
Ashley Shive 9/28/24
Vickie Koenig 9/30/2024
Samuel Graves
Remove remaining fuel out of tank(using the safest method), contain & absorb any fuel in the canal
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.09.30 08:59:19 -04'00'
Ashley Shive Digitally signed by Ashley Shive Date: 2024.09.28 16:21:37 -04'00'
Gracie Brinson Digitally signed by Gracie Brinson Date: 2024.09.28 15:01:14 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.09.29 16:21:47 -04'00'
File details come from the government source that posted it. Updated .