CN-370000-LE808-8I-72213.pdf
PDF 165 KB Posted
- Contract number
- LE808
- Issued by
- Florida
About this file
Summary of Work Authorization Form
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), and authorizes work to be performed by AOTC under Contract LE808. The incident (2025-8I-72213) occurred on February 25, 2025, at US 221 at Boyd Road in Perry, Taylor County, Florida, with Melissa Woehle serving as the On-Scene Coordinator and Derek Free as the contractor representative.
The scope of work involves responding to a spill of approximately 200 gallons of diesel and oil that contaminated a roadway and adjacent shoulder. The primary tasks include soil removal and transportation to a Treatment, Storage, and Disposal Facility (TSDF), with work to be completed using a supervisor, recovery technician, equipment operator, dump trucks with liners, and backhoe equipment. AOTC will handle line locates and Department of Transportation permitting while excavating contaminated soil using volatile organic compound (VOC) readings to confirm remediation, with subsequent proper disposal, backfill, and sodding as needed. The work is assigned as a fixed-price contract with a not-to-exceed amount of $35,000. Funding is allocated from Project LE 808, Organization Code 3704 0100 000, Object Code 131545, Fund Category 099001, with the amount of $35,000 approved and signed by all required parties on March 3-4, 2025.
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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 2025-8I-72213
LE808 Derek Free 2/25/25
US 221 at Boyd Rd Melissa Woehle
30.200148, -83.606340 850-245-2873
Perry Taylor 850.363.3695
X
200 gallons diesel and oil spilled to roadway with runoff to shoulder
Work Clothes
PM Dump Trucks with liner and cost plus
AOTC will handle line locates and DOT permitting. Excavate contaminated soil using VOC readings to confirm no contamination above screening levels remaining.
Provide for proper disposal, backfill, and sod as needed.
35,000
LE 808 3704 0100 000 FC 131545 099001 101492 35,000 00
Melissa Woehle 3/3/2025
Derek Free 03/04/25
Vickie Koenig 3/4/2025
Samuel Graves
✔ petroleum contamianted
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.03.04 13:16:55 -05'00'
Digitally signed by Derek Free Date: 2025.03.04 09:55:11 -05'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2025.03.03 17:06:25 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.03.04 13:08:08 -05'00'
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