CN-370000-LE810-4I-65796.pdf
PDF 270 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 Office of Emergency Response and authorizes work to be performed by Hull's Environmental Services under Contract LE810. The incident, numbered 2020-4I-65796, occurred on June 1, 2020, at the corner of North 56th Street and Acline Drive in Tampa, Hillsborough County. The on-scene coordinator is Lindsay Brantley, and the DEP representative is Michael Bevacqua.
The work involves spill response for approximately 15 gallons of motor oil and contaminated media that entered a catch basin in a storm drain following a vehicle accident. Hull's Environmental Services will provide cleanup services including 1 supervisor, 2 recovery technicians, a response truck, vacuum truck, 2 fifty-five-gallon drums, high-visibility vests, and personal protective equipment. The waste will be profiled and disposed of as used oil via the contractor. The work is assigned as a fixed price contract with a not-to-exceed amount of $2,500.00. Funding is allocated from Project Number LE810 with Organization Code 37040100000, Object Code 139900, Fund 099001, and Category/Year 101492. All required signatures were executed on June 2-3, 2020, with approval from the OER budget representative on June 3, 2020.
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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 2020-4I-65796
LE810 Mike Bevacqua 6/1/2020
Big Dog Express Corp Lindsay Brantley Corner of N 56th St. & Acline Dr. 813-470-5867
Tampa Hillsborough 813-399-0581
~ 15 gallons of motor oil and contaminated media
High Visibility Vest
~ 15 gallons of motor oil went into a catch basin in a storm drain due to a vehicle accident. Kitty litter and soil were used to dike the storm drain.
This is a high traffic area and Hull's will need to provide MOT.
2,500.00
Lindsay Brantley 6/2/2020
Michael Bevacqua 6/2/2020
Melissa Woehle
✔ Used Oil
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2020.06.02 15:42:25 -04'00'
Lindsay Brantley Digitally signed by Lindsay Brantley Date: 2020.06.02 15:36:55 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.06.02 16:58:25 -04'00'
LE810 37040100000 FC 139900 099001 101492 2500
Kristin Gousse 6/3/2020
File details come from the government source that posted it. Updated .