CN-370000-LE810-4I-66158.pdf
PDF 132 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), authorizing Hull's Environmental to perform emergency spill response work. The authorization corresponds to DEP Incident #2020-4I-66158, dated August 18, 2020, involving a vehicle accident resulting in oil discharge into a marsh in Polk County, Florida, along R.O.W. Crews Road near Lake Wales.
The scope of work consists of spill response and soil removal services, specifically the removal of oil-impacted vegetation and soil from a County Right-of-Way area. The incident involved an estimated 10 to 20 gallons of motor oil discharged into a marsh. Hull's Environmental is authorized to deploy absorbent boom and pads across the ditch, remove contaminated vegetation and soil, and place materials into a roll-off container and 55-gallon drums. The work assignment is structured as a fixed price contract with a not-to-exceed estimate of $8,500. The authorization identifies resource requirements including one supervisor, one recovery technician, one equipment operator, one pickup/van vehicle, one backhoe, one roll-off truck, 55-gallon drums, and one roll-off container. Analytical and disposal arrangements are managed via contractor. Funding is allocated from Project LE810, Organization Code 37040100000, Object Code 139900, Fund 099001, and Category/Year 101492. The authorization was executed with signatures from DEP Representative Domenic LetoBarone (August 19, 2020), Contractor Representative Mike Bevacqua (August 19, 2020), and OER Budget Representative Kristin Gousse (August 21, 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 2020-4I-66158
LE810 Mike Bevacqua 8/18/2020
Vehicle accident - oil discharge into marsh Domenic LetoBarone
R.O.W. Crews Rd. - side of road with RR Tracks 813-470-5920
Lake Wales Polk 813-299-3608
Please call to schedule at date and time
10 to 20 gallons of motor oil in a marsh on County Right-of-Way
1 1
1 D
Roll-off Truck
Deploy absorbent boom across ditch, remove oil impacted vegetation and soil and place into a roll-off, remove oiled debris/solid waste and place into a 55-gallon drum.
Leave pads and boom in waterway until residual sheens have dissipated. Use of a small backhoe with a claw may work best. Bring hand tools and waders as needed. Cones
8,500
LE810 37040100000 FC 139900 099001 101492 8500
Domenic LetoBarone 8/19/2020
Mike Bevacqua 8/19/2020
Kristin Gousse 8/21/2020
Melissa Woehle
Used oil contaminated vegetation and soil
Removal of oil impacted vegetation & soil. Deploy absorbent boom/pads
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.08.21 15:30:31 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2020.08.20 15:13:39 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2020.08.19 09:51:06 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.08.21 09:56:42 -04'00'
File details come from the government source that posted it. Updated .