CN-370000-LE809-2I70222Z.pdf
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- Contract number
- LE809
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection (DEP), Office of Emergency Response (OER), dated July 20-24, 2023. The form authorizes work to be performed by Cliff Berry Inc. under contract LE809 in response to DEP Incident #2023-2I-7022ZZ. The work site is located at 17th ST SW and 7th in Vero Beach, Indian River County, Florida. The incident involves an abandoned agricultural poly tank, with Joseph Deluna designated as the On-Scene Coordinator (OSC).
The authorized work involves vacuuming off liquids from a 500-gallon poly tank and hauling the empty tank to Cliff Berry Inc.'s yard in Fort Pierce for cutting and disposal as plastic waste. The work assignment is structured as a fixed-price contract with a not-to-exceed estimate of $3,000. Personnel allocated include one supervisor and two equipment operators, along with a vacuum truck and pickup/van. Analytical and disposal arrangements are to be handled via the contractor. Funding is allocated from Project No. LE809, Organization Code 37040100000, Object Code 131545, Fund 099001, Category 102577. All required approvals were obtained, with signatures from the DEP Representative (Joseph Deluna), Contractor Representative (Kelly Brandenburg), and OER Budget Representative (Amanda Lanphere) between July 20-24, 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
Cliff Berry Inc. 2023-2I-70222Z
LE809 Jon Katzor 7/19/2023
Abandoned Agricultural Tank Joseph Deluna
17th ST SW and 7th 561-681-6767
Vero Beach Indian River 954-658-8020
CBI to vacuum off liquids in tank and haul empty tank to CBI Yard in Fort Pierce to Cut and dispose of as plastic waste.
LE809 37040100000 FC 131545 099001 102577 3000 00
Joseph Deluna 7/20/2023
Kelly Brandenburg 7/21/2023
Amanda Lanphere 7/24/2023
✔ 500 Gal Poly Tank
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.07.24 11:47:03 -04'00'
Kelly Brandenburg Digitally signed by Kelly Brandenburg Date: 2023.07.21 12:12:15 -04'00'
Joseph Deluna Digitally signed by Joseph Deluna Date: 2023.07.20 15:56:42 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2023.07.24 10:30:31 -04'00'
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