CN-370000-LE809-3I-69046.pdf
PDF 131 KB Posted
- Contract number
- LE809
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection, Office of Emergency Response. The form authorizes emergency response work under contract LE809 with contractor Cliff Berry for incident number 2022-3I-69046C, dated May 16, 2022. The work location is at Michale G Rippe and Alico Road in Fort Myers, Lee County, Florida. Key personnel involved include Bill Reasoner (DEP Representative), John Yanc (OSC), William Reasoner (Contractor Representative), and Amanda Lanphere (OER Budget Representative).
The authorization covers spill response and overpack drum services with the primary objective of removing damaged one-gallon containers into over-pack containers for disposal. The suspected material is muratic acid in an unspecified quantity. The scope of work requires one supervisor, one recovery technician, one field chemist, one response truck, and five 55-gallon drums. The work assignment is structured as a fixed price with a total authorized amount of $6,500.00, funded through project number LE809, organization code 37040100000, object code 139900, and fund category 099001 for fiscal year 101492. All required signatures were executed between July 27, 2022, and November 7, 2022.
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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 2022-3I-69046C
LE809 Bill Reasoner 5/16/2022
Michale G Rippe and Alico Road John Yanc
Michale G Rippe and Alico Road 239-344-5647
Fort Myers Lee 239-771-0500
Muratic Acid
C
6500.00
LE809 37040100000 FC 139900 099001 101492 6500 00
John Yanc 7/27/2022
William Reasoner 7/27/2022
Amanda Lanphere 11/07/2022
Samuel Graves
✔ 5
Remove damaged 1 gallon containers into over pack and disposal
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.11.07 11:30:04 -05'00'
William Reasoner Digitally signed by William Reasoner Date: 2022.07.27 13:28:46 -04'00'
John Yanc Digitally signed by John Yanc Date: 2022.07.27 13:20:09 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.10.28 09:57:49 -04'00'
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