CN-370000-LE810-2I-67170.pdf
PDF 131 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection's Office of Emergency Response, dated March 8, 2021. The form authorizes work under contract LE810 between the Department and Hulls Environmental Services, with Ben Skidmore serving as the contractor representative and Jose Blanco as the On-Scene Coordinator. The incident, numbered 2021-2I-67170, involves a diesel fuel discharge at the northwest corner of SR 70 and NE 128th Avenue in Okeechobee, Okeechobee County.
The work scope includes remediation of petroleum-soiled soil, requiring contractors to obtain DOT and line locate permits, locate the extent of contamination, remediate the affected area, obtain photoionization detector readings to confirm removal of volatile organic compounds, transport impacted soil for disposal, and replace the affected soil with new soil and seed or sod. The authorization is structured as a fixed-price contract with a not-to-exceed amount of $17,000, funded through Project No. LE810, Organization Code 37040100000, Object Code 139900, and Fund Category/Year 099001 101492. The suspected material is diesel fuel not exceeding 200 gallons. Approved signatures from the DEP Representative (Jose Blanco), Contractor Representative (Ben Skidmore), and OER Budget Representative (Kristin Gousse) were obtained between March 12 and March 18, 2021.
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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
Hulls Environmental 2021-2I-67170
LE810 Ben Skidmore March 8, 2021
A. Morales Trucking Discharge Jose Blanco
NW corner of SR70 & NE128th Ave Intersection
Okeechobee Okeechobee 954-685-4506 call to schedule
Diesel Fuel, not more than 200 gallons
2 D
Obtain DOT and line locate permits. Locate extent of contaminated area. Remediate contaminated area, Obtain PID readings on remaining soil to ensure no VOCs remain. Transport impacted soil for disposal. Replace impacted soil with new soil and seed area or lay sod.
17,000
LE810 37040100000 FC 139900 099001 101492 17000
Jose Blanco
Ben Skidmore 3-15-2021
Kristin Gousse 3-18-21
Cory Dilmore
Diesel impacted soil
Remediation of petroleum soiled soil.
Kristin Gousse Digitally signed by Kristin Gousse Date: 2021.03.18 15:25:54 -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: 2021-03-15 15:02-04:00
Jose Blanco Digitally signed by Jose Blanco Date: 2021.03.12 19:22:04 -05'00'
Cory Dewayne Dilmore Digitally signed by Cory Dewayne Dilmore Date: 2021.03.18 16:25:42 -04'00'
File details come from the government source that posted it. Updated .