CN-370000-LE809-4I-71565.pdf
PDF 466 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 (FDEP), Office of Emergency Response (OER). The document authorizes work to be performed by Cliff Berry Inc. under Contract LE809, with Jon Sandora as the authorized representative. The incident involves a spill response at the 7600 Block of Detroit Avenue in Hudson, Pasco County, Florida, with DEP Incident #2024-4I-71565 (FD096) dated 9/29/24. Jonathian Belcher serves as the On-Scene Coordinator (OSC) for this emergency response authorization.
The authorized work includes immediate spill response and soil removal activities related to waste oil and petroleum contact water with possibly contaminated soil totaling approximately 100 gallons or more. The level of effort encompasses one recovery technician, one equipment operator, and equipment including a response truck, vacuum truck, backhoe or similar machinery, vacuum hoses, work clothes PPE, and sampling gear (EPA Level 2). Analytical and disposal arrangements are to be handled via the contractor. The work assignment is on a fixed price basis with a not-to-exceed estimate amount of $7,500. Funding is allocated from Project No. LE 809, Organization Code 3704 0100 000, Object Code 131545, Fund 099001, Category/Year 101492, for a total amount of $7,500.00. The authorization was approved on 9/29/24 by FDEP Representative Gracie Brinson and OER Budget Representative Vickie Koenig.
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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
File details come from the government source that posted it. Updated .