CN-370000-LE810-1I-67899.pdf
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- Contract number
- LE810
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection's Office of Emergency Response and authorizes Hull's Environmental Services to perform emergency response work under Contract #LE810. The authorization was issued on June 24, 2021, for an incident located at 3165 CR 208 in St. Augustine, St. Johns County, Florida, with incident number 2021-11-67899. The authorized representatives include Kajani Cole (DEP), Scott Fullerton (Contractor), and Precious Boatwright (OER Budget Rep).
The work scope involves soil removal and petroleum-impacted debris remediation at the specified location. The project requires approximately 650 feet of ditch line drainage and excavation at a depth of 1 to 1.5 feet, with removal of 8,000 to 10,000 gallons of petroleum-impacted water before excavation commences. Equipment and personnel allocated include one supervisor, one recovery technician, one equipment operator, vacuum truck, pickup or van, backhoe or similar equipment, and 8 to 10 yard roll-off containers. The work is assigned as a fixed-price contract with a not-to-exceed estimate of $35,000.00, funded through Project Number LE810 under Organization Code 37040100000, Object Code 139900, and Fund Category 099001 (101492/00). All required signatures were obtained between July 30 and August 5, 2021.
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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
Hull's Environmental Services 2021-1I-67899
LE810 06/24/21
CR 208 Kajani Cole
3165 CR 208 (904)256-1692
St. Augustine St. Johns (904)510-2643
70 gallons of diesel and oil
1 8-10 20 yd r/o
Approximately 650 feet of ditch line to be drained and excavated 1'-1 1/2'. 8000 to 10000 gallons of Petroleum Impacted Water to be removed before excavation strarts.
Earthen dams to be built to ensure no water flow into the excavation. Additional Semi and lowboy trailer added to equipment
35000.00
LE810 37040100000 FC 139900 099001 101492/00 35,000 00
Kajani Cole 7/30/2021
Scott Fullerton 08/02/2021
Precious Boatwright
Petroleum Impacted Soil and Debris
Precious Boatwright Digitally signed by Precious Boatwright Date: 2021.08.05 09:50:13 -04'00'
Scott Fullerton Digitally signed by Scott Fullerton Date: 2021.08.02 16:23:52 -04'00'
Kajani Cole Digitally signed by Kajani Cole Date: 2021.07.30 15:25:01 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2021.08.03 13:37:05 -04'00'
File details come from the government source that posted it. Updated .