CN-370000-LE810-2C-66488.pdf
PDF 162 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection, Office of Emergency Response. The form authorizes Hull's Environmental Services to perform emergency response work under contract number LE810. The authorization covers response to a vessel explosion and fire incident (DEP Incident #2020-2C-66488) that occurred on October 15, 2020, at 1513 SW 17th Street in Fort Lauderdale, Broward County. Zachary Shulman serves as the On-Scene Coordinator, with Tim Francis designated as the contractor representative.
The work involves spill response operations for a fuel spill (likely gasoline) with at least 40 gallons released from the vessel and an unknown amount remaining in tanks. The scope includes one supervisor, two recovery technicians, and one equipment operator, utilizing response trucks, a vacuum truck, pickup vehicles, hard and soft boom, absorbent pads, response pads, and an ERT trailer. Personnel will wear work clothes with PPE Level designation. The contractor will profile waste as non-regulated petroleum-contaminated water. The work assignment is authorized as a fixed-price engagement with a not-to-exceed estimate of $10,000. Funding is allocated from project LE810, organization code 37040100000, object code 139900, fund category 099001, and fund year 101492. The form was executed and approved on October 19-22, 2020, by representatives from the contractor, DEP, and the OER budget office.
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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 2020-2C-66488
LE810 Tim Francis October 15, 2020
New River Vessel Fire Zach Shulman
1513 SW 17th St 561-681-6767
Ft. Lauderdale Broward 954-658-8021
Fuel (likely gasoline), At least 40 gallons released from vessel. Unknown amount in tanks
1 Work Clothes
Hard & Soft Boom
Absorbent Pads, Response Pads, ERT Trailer.
10,000
LE810 37040100000 FC 139900 099001 101492 10000
Zachary Shulman 10/19/20
Ben Skidmore 10-21-2020
Kristin Gousse 10/22/2020
Melissa Woehle
✔ Non Regulated Petroleum Contaminated Water
Vessel Explosion/Fire
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.10.22 15:35:43 -04'00'
Zachary Shulman Digitally signed by Zachary Shulman Date: 2020.10.22 11:33:33 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.10.22 13:49:57 -04'00'
File details come from the government source that posted it. Updated .