CN-370000-LE810-1I72950C.pdf
PDF 160 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 (DEP), Office of Emergency Response (OER). The form authorizes Hull's Environmental to perform emergency response work under Contract LE 810. The incident (DEP Incident #2025-1I-72950C) occurred on July 11, 2025, at the intersection of 9th Street and Phoenix Avenue in Jacksonville, Duval County. The On-Scene Coordinator is Gracie Brinson, with Larry Hall serving as the contractor representative.
The authorized work includes spill response and soil removal for used motor oil contamination, with transport of drums to a Treatment, Storage, and Disposal Facility (TSDF). The work authorization specifies a fixed price of $6,000 with a not-to-exceed estimate amount of $6,000. Personnel assigned include one supervisor, two recovery technicians, one equipment operator, and one driver. Equipment authorized includes a pickup or van, backhoe or similar equipment, roll-off containers with liner, and work clothing. Analytical and disposal arrangements are to be handled via the contractor. Funding is allocated from Project LE 810, Organization Code 3704 0100 000, with the amount of $6,000 charged to Object Code 131545, Fund 099001, Category/Year 101492. All required signatures from the DEP Representative, Contractor Representative, and OER Budget Representative were obtained between July 16 and July 17, 2025.
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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 2025-1I-72950C
LE 810 Larry Hall 7/11/25
9th & Phoenix Gracie Brinson
9th St. @ Phoenix 904-256-1528
Jacksonville Duval 904-237-6261
July 25, 2025 0800
Used motor oil
2 1
1 Work clother
Driver Roll-Off truck & liner
Some of the area may need to be hand dug.
6,000
LE 810 3704 0100 000 FC 131545 099001 101492 6,000 00
Gracie Brinson July 16, 2025
Larry Hall July 16, 2025
Vickie Koenig 7/17/2025
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.07.17 08:18:57 -04'00'
Larry Hall Digitally signed by Larry Hall Date: 2025.07.16 16:32:47 -04'00'
Gracie Brinson Digitally signed by Gracie Brinson Date: 2025.07.16 16:07:46 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.07.17 08:41:56 -04'00'
File details come from the government source that posted it. Updated .