CN-370000-LE809-3I-72269.pdf
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- 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 (FDEP), Office of Emergency Response (OER). The document authorizes work to be performed by Cliff Berry Inc. under Contract LE 809 in response to DEP Incident #2025-3I-72269. The incident occurred on February 26, 2025, at SR 78/Roberson Drive in Moore Haven, Glades County, Florida. Dave Glen serves as the On-Scene Coordinator for the FDEP, with Robert Summers representing the contractor and Vickie Koenig serving as the OER Budget Representative.
The work authorization covers full site remediation services resulting from a semi-truck accident that released approximately 150 gallons of diesel fuel and a small quantity of hydraulic fluid onto soil. The scope of work includes assessing the site, removing all impacted soil with assistance from the Property Identification Division and an excavator, and replacing affected areas with fresh sod once contamination readings fall below 10 parts per million (ppm). All impacted material will be disposed of accordingly. The work assignment is structured as a fixed-price contract with a not-to-exceed estimate amount of $26,000.00. The contractor will utilize two CDL drivers, supervisory and field personnel, response vehicles (straight truck and backhoe), roll-off containers (1-2), and a vapor detector. Funding is allocated from Project LE 809, Organization Code 3704 0100 000, with Object Code 131545 and Fund Category/Year 099001/101492. All required approvals were obtained between March 13, 2025, and March 21, 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
Cliff Berry Inc. 2025-3I-72269
LE 809 Robb Summers 2/26/2025
SR 78 / Roberson Dr. Dave Glen
SR 78 / Roberson Dr. 239-633-5441
Moore Haven Glades 239-633-5441
Dave Glen @ 239-633-5441
150 gallons Diesel along with few gallons hydraulic fluid.
1 - 2
D
CDL Driver x 2
Asses site, remove all impacted soil with assistance from PID and excavator, replace with fresh sod once readings are below 10 ppm. Dispose all impacted material accordingly.
26,000.00
LE 809 3704 0100 000 FC 131545 099001 101492 26,000 00
Dave Glen 3-13-2025
Robert Summers 3/19/2025
Vickie Koenig 3/21/2025
Samuel Graves
✔ Diesel impacted soil
Full site remediation from semi accident w/ 150 gallons diesel on soil.
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.03.21 16:31:48 -04'00'
Robert C. Summers, Jr., P.G.
Digitally signed by Robert C. Summers, Jr., P.G.
Date: 2025.03.19 11:07:31 -04'00'
David Glen Digitally signed by David Glen Date: 2025.03.13 12:33:29 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.03.24 10:19:33 -04'00'
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