CN-370000-LE809-4I-68982.pdf
PDF 159 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 document authorizes work to be performed by Cliff Berry Inc under Contract LE809 for incident 2022-41-68982. The work is located at 1202 Vista Way, Clearwater, Pinellas County, Florida, with Sean Lynch designated as the On-Scene Coordinator. Key personnel involved in the authorization include DEP Representative Sean Lynch, Contractor Representative Jon Sandora, and OER Budget Representative Amanda Lanphere.
The authorization directs Cliff Berry Inc to pick up and remove an abandoned 55-gallon drum containing approximately 40 gallons of used/water down gasoline from the Vista Way Drum Clearwater site for disposal. The work assignment is structured as a fixed price agreement with a not-to-exceed estimate amount of $2,000. The contracted work includes one Recovery Technician and one Response Truck. Funding for this $2,000 authorization is allocated from Project LE809, Organization Code 37040100000, with Object Code 131545, Fund Category/Year 102577, and Fund 099001. All required signatures were executed between November 3, 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 Inc 2022-4I-68982
LE809 Jon Sandora 11-2-2022
Vista Way Drum Clearwater Sean Lynch
1202 Vista Way 813-470-5925
Clearwater Pinellas 813-244-2934
Used/ Water down Gasoline ~40 gallons.
Pick up for removal and disposal.
2,000
LE809 37040100000 FC 131545 099001 102577 2000 00
Sean Lynch 11/3/2022
Jon Sandora 11/3/2022
Amanda Lanphere 11/7/2022
Samuel Graves
✔ 55 gall
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.11.07 17:10:14 -05'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2022.11.03 10:42:54 -04'00'
Sean Lynch Digitally signed by Sean Lynch Date: 2022.11.03 10:53:08 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.11.07 14:17:57 -05'00'
File details come from the government source that posted it. Updated .