CN-370000-LE810-2I-66200.pdf
PDF 132 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection, Office of Emergency Response. The form authorizes Hull's Environmental Services to conduct emergency response work under Contract #LE810. The incident involved a diesel fuel spill in Okeechobee County, Florida, and was assigned DEP Incident #2020-2I-66200, with an incident date of 8/14/20.
The authorized work includes immediate spill response and soil removal from a stormwater ditch where approximately 20 gallons of diesel fuel were dumped. The response involves deploying a supervisor, two recovery technicians, and equipment operator with multiple vehicles including a response truck, vacuum truck, pickup/van, and backhoe, along with three 55-gallon drums and one roll-off container. Analytical services are to be provided via contractor. The work assignment is structured as a fixed price contract with a not-to-exceed estimate of $15,000, funded through Project No. LE 810 with Organization Code 37040100000. The authorization was executed on 8/24/20 with signatures from DEP Representative Jamie Arleo, Contractor Representative Ben Skidmore, and OER Budget Representative Kristin Gousse, with final approval from Melissa Woehle on 8/26/20.
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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 2020-2I-66200
LE810 Ben Skidmore 8/14/20
N/A Jamie Arleo
3789 SE 6th Street 813-470-5923
Okeechobee Okeechobee 813-267-3561
Meet on-site at 08/22/20 @ 4:00 PM
~ 20-gals of diesel fuel were dumped/spilled into a stormwater ditch. Weathered free product was found in numerous stormwater drains in the area.
2 1
D
Roll-off Truck
A vacuum truck will be needed to recovery the free product and PCW from the stormwater drain system. Sorbent boom will be left in the stormwater drain system to recover any residual fuel.
The contaminated soil/vegetation will need to be excavated from the impacted stormwater ditch.
15,000
LE 810 37040100000 FC 139900 099001 101492 15000
Jamie Arleo 08/24/20
08/24/2020
Kristin Gousse 8/26/2020
Melissa Woehle
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.08.26 10:33:25 -04'00'
Ben Skidmore Digitally signed by Ben Skidmore DN: cn=Ben Skidmore gn=Ben Skidmore c=US United States l=US United States o=Hull's Environmental Services ou=Operations e=bskidmore@hullsenv.com Reason: I am the author of this document Location:
Date: 2020-08-24 10:47-04:00
Jamie Arleo Digitally signed by Jamie Arleo Date: 2020.08.24 10:30:59 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.08.24 17:01:07 -04'00'
Owner Typewritten text Ben Skidmore
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