CN-370000-LE809-2I-70535.pdf

This is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection, Office of Emergency Response, for a spill response incident. The contractor is CBI, represented by Dave Hickey, and the work site is the Palm Beach Pool Equipment Spill located at 4310-23rd Boulevard Road in West Palm Beach, Palm Beach County, Florida. The incident occurred on October 2, 2023, with the DEP Incident number 2025-21-Tic-15. The on-scene coordinator is Joseph Deluna, and the authorization was approved on December 24, 2025.

The work authorization covers spill response services requiring immediate action, specifically the removal of chlorine, muriatic acid containers, and sodium bicarbonate from the pool facility. Personnel deployed include a supervisor, recovery technician, equipment operator, and foreman, with equipment consisting of a response truck, vacuum truck, pickup truck or trailer, and a 55-gallon drum. The PPE level is specified as Level 1. The work is classified as fixed price with a not-to-exceed estimate of $5,000. Funding is sourced from Project Number IE809, Organization Code 3704010000.00, with the fund code 099001 and allocation number 101492, dated December 24, 2025. Analytical and disposal arrangements will be documented separately through the Chain-of-Custody form.