CN-370000-LE810-4167482C.pdf
PDF 132 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, Office of Emergency Response, authorizing Hull's Environmental to perform emergency spill response work under Contract #LE810. The work is associated with DEP Incident #2021-4I-67482C, dated April 23, 2021, and involves response to an illegal dumping incident on a Hillsborough County right-of-way across from 4110 Cooper Road in Plant City. The on-scene coordinator is Domenic LetoBarone, with Mike Bevacqua serving as the contractor's representative.
The work authorization authorizes Hull's Environmental to vacuum recoverable used motor oil from a waterway, deploy absorbent pads and boom, excavate impacted oily vegetation and soils, and arrange necessary permits and maintenance of traffic. The scope includes mobilization of one supervisor, two recovery technicians, and one equipment operator, supported by response vehicles including a vacuum truck, pickup or van, and backhoe, along with ten 55-gallon drums and one lined roll-off container. The work is assigned as a fixed-price contract with a not-to-exceed amount of $18,000.00. Funding is provided from Project No. LE810, Organization Code 37040100000, Object Code 139900, Fund Category 099001, for a total authorized amount of $18,000. The work authorization was executed and approved by all required parties between April 23-25, 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
Hull's Environmental 2021-4I-67482C
LE810 Mike Bevacqua 4/23/2021
Used oil dumping on County R.O.W. Domenic LetoBarone
County R.O.W. across from 4110 Cooper Road 813-470-5920
Plant City Hillsborough 813-299-3608
Schedule is open Wed. to Friday
~ 25+ gallons of used motor oil was illegally dumped into a waterway & wetlands on County Right-of-Way
2 1 lined box
1 Level D work boat
Vacuum recoverable oil from the waterway. Deploy pads and absorbent boom. Excavate impacted oily vegetation/soils. Disposal. Arrange necessary permits and M.O.T. *** This is an active Law Enforcement investigation ***
18,000.00
LE810 37040100000 FC 139900 099001 101492 18,000
Domenic LetoBarone 4/23/2021
Mike Bevacqua 4/23/2021
Kristin Gousse 4/25/2021
Cory Dilmore
Used oil contaminated soils / oily water
Vacuum recoverable product, deploy pads & boom, disposal, excavate soils
Kristin Gousse Digitally signed by Kristin Gousse Date: 2021.04.25 14:37:14 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2021.04.25 10:05:51 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2021.04.23 21:54:26 -04'00'
Cory Dewayne Dilmore Digitally signed by Cory Dewayne Dilmore Date: 2021.04.25 11:26:33 -04'00'
File details come from the government source that posted it. Updated .