CN-370000-LE810-4I-66390.pdf
PDF 132 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13, effective July 1, 2017) is issued by the Florida Department of Environmental Protection's Office of Emergency Response for an emergency spill response contract with Hull's Environmental. The authorization covers response services for a hazardous materials incident (DEP Incident #2020-4I-66390) located at CR-640 and Old Highway 37 in Mulberry, Polk County, Florida. The responsible parties include DEP Representative Domenic LetoBarone, Contractor Representative Mike Bevacqua, and OER Budget Representative Kristin Gousse, with Melissa Woehle serving as the approving DEP Contract Manager.
The work involves immediate response to an illegal dumping incident involving approximately 20 gallons of used motor oil on a county right-of-way. Services required include soil removal, excavation with heavy equipment (backhoe with long reach), and backfill and sod restoration to prevent soil erosion along the embankment. The work is assigned as a fixed-price contract with a not-to-exceed amount of $11,000.00. Personnel include one supervisor and two recovery technicians, along with one pickup/van, one backhoe, one roll-off container, and mobilization of traffic control (MOT) services. Waste will be profiled as used oil contaminated soils and handled via the contractor. Funding is allocated from Project No. LE810, Organization Code 37040100000, Object Code 139900, Fund Category/Year 099001/101492, with authorization dated October 1-8, 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-66390
LE810 Mike Bevacqua 9-30-2020
20-gallon used oil dumping on County R.O.W. Domenic LetoBarone
CR-640 and Old Highway 37, N27.85065, W -81.96861 813-299-3608
Mulberry Polk 813-299-3608
Let's schedule for next week - Thursday or Friday
~ 20-gallons of used motor oil was illegally dumped on County R.O.W. The spill area is ~ 10' x 10' x 1'
2 1
1 D & Safety Vests
Roll-off Truck
The spill is in a very dangerous location due to an elevated intersection, which is also around a curve. A lane closure and full MOT will be needed. Law Enforcement may be needed, I can check with DEP's Investigators. One roll-off should be adequate to remove all impacted soils. An excavator with a long reach will be needed if digging from across the guardrail.
11,000.00
LE810 37040100000 FC 139900 099001 101492 11000
Domenic LetoBarone 10-1-2020
Mike Bevacqua 10-1-2020
Kristin Gousse 10/08/2020
Melissa Woehle used oil contaminated soils
Backfill and sod due to slope of embankment to prevent wash out of clean soil
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.10.08 10:54:42 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2020.10.07 16:40:24 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2020.10.01 07:58:30 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.10.07 17:50:44 -04'00'
File details come from the government source that posted it. Updated .