CN-370000-LE810-41-67890.pdf
PDF 131 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 document authorizes Hull's Environmental Services, Inc. to perform emergency response work under Contract #LE810. The incident occurred on July 13, 2021, in Progress Village, Hillsborough County, Florida, near the intersection of S 78th Street and Madison Avenue, with Trevor Wavelet designated as the On-Scene Coordinator.
The work involves spill response and soil removal services related to approximately 10 gallons of oil dumping into a storm drain with minor soil contamination. The authorized scope includes deployment of a response trailer, vacuum truck to remove free product from the stormwater drain, sorbent pads and boom, and minor soil excavation with materials placed in drums for disposal. The work is authorized on a fixed-price basis with a not-to-exceed estimate amount of $7,000. Personnel assigned include 1 supervisor and 2 recovery technicians, with equipment including a response truck, vacuum truck, pickup or van, and 5 fifty-five-gallon drums. Analytical and disposal arrangements are handled via the contractor. Funding is allocated from Project LE810, Organization Code 37040100000, with the amount of $7,000 charged to Fund Category/Year 101492/00. The authorization was signed and approved on July 22, 2021, by DEP Representative Trevor Wavelet, Contractor Representative Mike Bevacqua, and OER Budget Representative Precious Boatwright.
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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, Inc. 2021-4I-67890
LE810 Mike Bevacqua 07/13/21
Near Family Dollar Oil Dumping Trevor Wavelet
S 78th St & Madison Ave 813-470-5946
Progress Village Hillsborough 813-399-0581
Approximately 10 Gallons of oil dumping into a storm drain and minor soil contamination around storm grate.
work clothes
Response Trailer
Vacuum truck will used to remove free product from stormwater drain. Sorbent pads/boom deployed. Minor soil excavation will be required and materials will be placed in drums for disposal.
LE810 37040100000 FC 139900 099001 101492/00 7000 00
Trevor Wavelet
Mike Bevacqua 7/22/2021
Precious Boatwright
Precious Boatwright Digitally signed by Precious Boatwright Date: 2021.07.22 15:27:41 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2021.07.22 10:18:44 -04'00'
Trevor Wavelet Digitally signed by Trevor Wavelet Date: 2021.07.22 09:36:58 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2021.07.26 14:58:46 -04'00'
File details come from the government source that posted it. Updated .