CN-370000-LE810-1I-69031.pdf
PDF 180 KB Posted
- 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. The document authorizes work to be performed by Hull's Environmental Services under Contract LE 810 for incident number 2022-1I-69031. The incident site is located at the 9300-9500 block of Historic Kings Road South in Jacksonville, Duval County, Florida. Key personnel include Larry Hall as the contractor representative, Brierra T. Mack as the On-Scene Coordinator, and Amanda Lanphere as the OER Budget Representative.
The work authorization covers spill response and soil removal services related to an estimated 125-gallon road diesel release from a punctured abandoned tractor trailer saddle tank at the Historic Kings Road South location. The authorized scope includes excavation activities with equipment consisting of a roll-off truck and mini excavator, and staffing of one supervisor and two recovery technicians. The work assignment is designated as fixed price with a not-to-exceed estimate amount of $8,000. Funding is sourced from Project LE 810, Organization Code 3704010000, Object Code 139900, and Fund Category 101492. The work authorization was executed with signatures from the DEP representative (May 19, 2022), contractor representative (May 23, 2022), and OER budget representative (May 23, 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
Hull's Environmental Services 2022-1I-69031
LE 810 Larry Hall May 16, 2022
Historic Kings Road S Diesel Spill Brierra T. Mack
9300-9500 block Historic Kings Road S. 904-256-1679
Jacksonville Duval 904-673-5357
To be determined. Waiting for truck removal by COJ
15'x30' soil area imapcted by an estimated 125 gallons of road diesel release from a punctured abandoned tractor trailer saddle tank
2 2
1 Work Clothes
Roll-off Truck, mini excavator, skid stee
DEP OER will conduct soil OVA field screening during excavation.
Soil OVA field screening conducted on 5/16/2021 ranged 43-53 ppm.
8,000
LE 810 3704010000 FC 139900 099001 101492 8000 00
Brierra T. Mack May 19, 2022
Larry Hall May 23, 2022
Amanda Lanphere May 23, 2022
Samuel Graves
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.05.23 16:03:55 -04'00'
Larry Hall Digitally signed by Larry Hall Date: 2022.05.23 13:52:17 -04'00'
Brierra Mack Digitally signed by Brierra Mack Date: 2022.05.19 11:01:06 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.05.23 14:16:50 -04'00'
File details come from the government source that posted it. Updated .