CN-370000-LE810-1I-70766.pdf
PDF 183 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection's Office of Emergency Response. The form authorizes work to be performed by Hull's Environmental Services under Contract LE 810, with Larry Hall serving as the contractor representative and Brierra T. Mack as the On-Scene Coordinator. The incident, identified as DEP Incident #2024-11-70766, occurred on January 9, 2024, at 76 Yellow Water Road in Baldwin, Duval County, Florida.
The work authorization covers spill response and soil removal services for approximately 30 gallons of vehicular diesel-impacted soil and petroleum-contaminated water affecting approximately 50 square meters. The level of effort includes one supervisor, one recovery technician, and one equipment operator, along with necessary vehicles (pickup/van, backhoe) and equipment (visqueen, roll-off container with liner, work clothes, and MOT/temporary traffic control). Additional support services include backfill soil, a driver for disposal transport, and temporary traffic control consisting of lane closure, two flaggers, and a police officer. The work is assigned as a fixed-price authorization with a not-to-exceed estimate of $10,600, funded through Project LE810, Organization Code 3704 0100 000, Object Code 131545, Fund Category 0990001, and Category Year 101492. The authorization was executed with signatures from the DEP representative (January 24, 2024), contractor representative (January 26, 2024), and OER Budget representative (January 29, 2024).
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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 2024-1I-70766
LE 810 Larry Hall January 9, 2024
Yellow Water Road Brierra T. Mack
76 Yellow Water Road 904-256-1679
Baldwin Duval 904-673-5357
Approximately 30 gallons of vehicular diesel impacted soil, and PCW. Affected area is about 50 sq meters.
1 1 with liner
1 Work Clothes
Driver Roll off truck, skid steer
Backfill soil needed. Driver for disposal transport. MOT/Temporary Traffic Control= lane closer, 2 flaggers, police officer
10, 600
LE810 3704 0100 000 FC 131545 0990001 101492 10,600 00
Brierra T. Mack January 24, 2024
Larry Hall January 26, 2024
Vickie Koenig January 29, 2024
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.01.29 13:40:15 -05'00'
Larry Hall Digitally signed by Larry Hall Date: 2024.01.26 12:24:47 -05'00'
Brierra Mack Digitally signed by Brierra Mack Date: 2024.01.24 12:56:58 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.01.29 14:02:36 -05'00'
File details come from the government source that posted it. Updated .