CN-370000-LE810-4167294.pdf
PDF 131 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response, and authorizes work to be performed by Hull's Environmental Services, Inc. under contract LE810. The form documents emergency response activities for DEP Incident #2021-4I-67294, dated March 29, 2021, at the SR-64 and Dam Road location in Bradenton, Manatee County. The on-scene coordinator is Jamie Arleo, with Mike Bevacqua serving as the contractor representative.
The authorization covers spill response and soil removal services for approximately 100 gallons of diesel fuel and 10 gallons of motor oil released into a wetlands area. The scope of work includes deployment of sorbent pads and boom, removal of free product using a vacuum truck, excavation with removal of contaminated surface and groundwater, and potential sampling and traffic management operations. The work authorization is issued on a fixed-price basis with a not-to-exceed amount of $22,727.32. Funding is allocated from project LE810 using organization code 37040100000, object code 139900, and fund category 212001 (104132). All required signatures were obtained by June 30, 2021, including approvals from the DEP representative, contractor, and OER budget representative.
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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-67294
LE810 Mike Bevacqua 03/29/21
Jamie Arleo
SR-64 and Dam Rd 813-470-5923
Bradenton Manatee 813-267-3561
Approximately 100-gals of diesel fuel and 10-gals of motor oil released into a wetlands area. Wetlands area leaching free product.
3 3
1 work clothes
Response Trailer roll-off liner
Vacuum truck will used to remove free product from stormwater ditch. Sorbent pads/boom deployed. Excavation will be required with removal of surface/groundwater.
MOT could be required for excavation. Sampling of surface/groundwater could be required. Removal of contaminated surface water/groundwater will continue at site.
22,727.32
LE810 37040100000 JC 139900 212001 104132 22,727 32
Jamie Arleo 6/2/21
Michael Bevacqua 6/2/21
Kristin Gousse 6/30/2021
Cory Dilmore
Kristin Gousse Digitally signed by Kristin Gousse Date: 2021.06.30 16:36:49 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2021.06.02 11:46:03 -04'00'
Jamie Arleo Digitally signed by Jamie Arleo Date: 2021.06.02 10:49:38 -04'00'
Cory Dewayne Dilmore Digitally signed by Cory Dewayne Dilmore Date: 2021.06.11 09:30:44 -04'00'
File details come from the government source that posted it. Updated .