CN-370000-LE810-1I69031.pdf
PDF 204 KB Posted
- Contract number
- GC153
- Issued by
- Florida
About this file
This document is a Work Authorization Form (WAF) from the Florida Department of Environmental Protection's Office of Emergency Response, involving Hull's Environmental Services as the contractor. The incident involves a diesel spill at Historic Kings Road S. in Jacksonville, Duval County, with Brierra T. Mack serving as the On-Scene Coordinator (OSC) and Larry Hall representing the contractor.
The work authorization covers a spill response and soil removal project, including transporting drums to a Treatment Storage and Disposal Facility (TSDF), sampling, and analysis of petroleum-contaminated soil. The contract is fixed-price with a not-to-exceed amount of $5,000.00, funded through project LE810 with specific organizational and object codes. The contractor is authorized to conduct immediate response activities, including overpack and transport of drums, soil removal, and sample analysis. The document notes that the contracted job exceeded the original cost estimate, and was approved and signed by the DEP representative, contractor representative, and OER budget representative on 7/13/2022.
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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
LE810 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
June 1, 2022
Petroleum contaminated soil
The contracted job exceeded original cost estimate.
5,000.00
Brierra T. Mack 7/13/2022
Brierra Mack Digitally signed by Brierra Mack Date: 2022.07.13 15:15:08 -04'00'
Larry Hall 7/13/2022
LE810 37040100000 FC 139900 099001 101492 5000 00
Amanda Lanphere 7/13/2022Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.07.13 16:15:21 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.07.13 16:29:11 -04'00'
File details come from the government source that posted it. Updated .