CN-370000-LE809-2I-70747.pdf
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- Contract number
- LE809
- Issued by
- Florida
About this file
Work Authorization Summary
This is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection (DEP), Office of Emergency Response (OER), dated January 8, 2024. The form authorizes emergency response work under contract LE809 with CBI (Environmental Remediation Holding Corporation). The incident, numbered 2023-2I-70747, occurred on December 28, 2023, at Lake Worth Road and State Road 7 in Wellington, Palm Beach County, Florida, and involved a diesel and hydraulic oil spill. The authorized representatives include Joseph Deluna (OSC/DEP), Robert Summers (Contractor), and Vickie Koenig (OER Budget Representative).
The work authorization covers spill response and soil removal services related to a diesel, hydraulic oil, and motor oil contamination incident. The scope includes mobilization of heavy equipment (tractor, trailer, dump truck, and backhoe) and deployment of four recovery technicians and two drivers to remove approximately 20 tons of contaminated soil for disposal. Equipment and materials specified include 55-gallon drums, visqueen, vapor detector, PPE Level work clothes, and MOT equipment. The work is authorized on a fixed-price basis with a not-to-exceed amount of $27,000. Funding is sourced from Project LE809, Organization Code 3704 0100 000, with allocation from Fund Category 101492, totaling $27,000.00.
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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
CBI 2023-2I-70747
LE809 John Stewart 12/28/2023
Diesel and Hyrdolic Oil Spill SR7 Joseph Deluna
Lake Worth Road and State Road 7 Lat /Long 26.6100 -80.20516 West Palm Beach
Wellington Palm Beach County 954-658-8020
Diesel , Hydraulic Oil , Motor Oil
1 Work Cloths
2 drivers
Tractor to bring Back Hoe on scene , Trailer , Dump Truck , Approximately 20 ton of soil for disposal
27,000
LE809 3704 0100 000 FC 131545 099001 101492 27,000 00
Joseph Deluna 1/08/2024
Robert Summers 1/8/2024
Vickie Koenig 1/8/2024
Samuel Gravecs
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.01.08 16:52:41 -05'00'
Robert C. Summres, P.G. Digitally signed by Robert C. Summres, P.G.
Date: 2024.01.08 12:21:50 -05'00'
Joseph Deluna Digitally signed by Joseph Deluna Date: 2024.01.08 10:48:00 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.01.08 13:41:03 -05'00'
File details come from the government source that posted it. Updated .