CN-370000-LE810-1I69031.pdf
PDF 204 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This Work Authorization Form (WAF) is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response, and authorizes work performed by Hull's Environmental Services under Contract LE810. The incident response involves cleanup operations at the Historic Kings Road S. location in Jacksonville, Duval County, Florida. The authorized work was initiated on June 1, 2022, with incident documentation dated May 16, 2022. DEP Representative Brierra T. Mack and Contractor Representative Larry Hall executed the authorization on July 13, 2022, along with OER Budget Representative Amanda Lanphere.
The scope of work encompasses spill response, soil removal, drum transportation to Treatment, Storage, and Disposal Facilities (TSDF), sampling, and analysis of petroleum-contaminated soil from a diesel spill. The work assignment was designated as fixed price with a not-to-exceed estimate amount of $5,000.00. The funding is allocated from Project LE810, Organization Code 37040100000, Object Code 139900, Fund Category 099001, funded through Category Year 101492. A comment notation indicates that the contracted job exceeded the original cost estimate. All required signatures were digitally executed on July 13, 2022, authorizing the full authorization amount of $5,000.00.
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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 .