CN-370000-LE810-1I71973C.pdf
PDF 182 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 (FDEP), Office of Emergency Response, and authorizes work performed by Hull's Environmental Services under contract number LE 810. The form documents authorization for emergency response services related to incident number 2025-11-7197-3C, occurring on January 18, 2025, at 9135 Herlong Road in Jacksonville, Duval County. The incident was managed by On-Scene Coordinator Brierra Mack, with Larry Hall serving as the contractor representative.
The work authorization directs Hull's Environmental Services to remove one 55-gallon drum containing unknown oily sludge waste and impacted soil from the incident site, with soil removal via hand excavation and placement of waste into 55-gallon drums for disposal. The work is assigned as a fixed price contract valued at $3,500.00, with the contractor providing one supervisor and two recovery technicians, one response truck, and work clothes as personal protective equipment. The work is funded through project number LE810 with organization code 37040100000, object code 131545, fund category 099001, and account 101492. All required signatures were executed between January 21 and February 3, 2025, with approval from the DEP representative, contractor, and OER budget representative.
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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 2025-1I-71973C
LE 810 Larry Hall January 18, 2025
Unknown Drum Incident Brierra Mack
9135 Herlong Road 904-256-1679
Jacksonville Duval 904-673-5357
Unknown grey oily waste solvent with high pH
Work Clothes
Remove (1) 55-gallon drum containing an unknown oily sludge waste and impacted soil. Remove soil via hand dig and place waste into 55 gallon drums for disposal.
$3500.00
LE810 37040100000 FC 131545 099001 101492 3,500 00
Brierra Mack January 21, 2025
Scott Fullerton January 27, 2025
Vickie Koenig 2/3/2025
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.02.03 14:37:13 -05'00'
ScottFullerton Digitally signed by ScottFullerton DN: cn=ScottFullerton gn=ScottFullerton c=US United States l=US United States o=Hull's Environmental Services ou=Jacksonville e=sfullerton@hullsenv.com Reason: I am the author of this document Location:
Date: 2025-01-27 09:20-05:00
Brierra Mack Digitally signed by Brierra Mack Date: 2025.01.21 14:41:57 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.02.03 15:19:26 -05'00'
File details come from the government source that posted it. Updated .