CN-370000-LE808-2I-70041.pdf
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- Contract number
- LE808
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (OER_13, Effective 7-01-2017) issued by the Florida Department of Environmental Protection, Office of Emergency Response (OER). The document authorizes emergency response work under Contract No. LE808 with AOTC (contractor), with John Yanc serving as the contractor representative. The authorization is related to incident 2023-2I-70041, occurring on May 17, 2023, at Hollywood Plaza, 201-225 N Park Road, Hollywood, Broward County, Florida. The On-Scene Coordinator (OSC) is identified as Deluna and George.
The work scope involves immediate spill response to address petroleum contamination from a plane crash, including vacuum removal of storm drains and proper disposal of recovered materials. The authorization specifies a fixed-price work assignment with a not-to-exceed estimate of $3,000. Required personnel include a supervisor and recovery technician, with equipment needs including a response truck, vacuum truck, and three 55-gallon drums. Analytical and disposal arrangements are to be handled by the contractor, with petroleum identified as the waste type requiring profiling. Funding is allocated from Project No. LE808, Organization Code 37040100000, Object Code 131545, Fund Category 212001, Account 101492. The authorization was executed and signed by all required parties on May 22, 2023 (DEP Representative Joseph DeLuna, OER Budget Representative Amanda Lanphere), with contractor approval on May 19, 2023.
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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
AOTC 2023-2I-70041
LE808 John Yanc 5/17/2023
Hollywood Plane Crash Deluna and George
Hollywood Plaza 201-225 N Park Rd 561-681-6767
Hollywood Broward 954-658-8020
Petroleum from plane crash
LE808 37040100000 JP 131545 212001 101492 3000 00
Joseph DeLuna 5/22/2023
John Yanc 5/19/2023
Amanda Lanphere 05/22/2023
Samuel Graves
Petroleum
✔ ✔ 3
Vacuum Storm drain and proper disposal
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.05.22 10:04:48 -04'00'
John Yanc Digitally signed by John Yanc Date: 2023.05.19 07:12:10 -04'00'
Joseph Deluna Digitally signed by Joseph Deluna Date: 2023.05.22 10:13:31 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2023.05.22 08:44:50 -04'00'
File details come from the government source that posted it. Updated .