CN-370000-LE810-4I-66518.pdf
PDF 131 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
Document Summary
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection's Office of Emergency Response for emergency spill response services. The document authorizes Hull's Environmental Services, Inc. (Contract #LE810) to conduct emergency response work at the incident location of US Highway 41 & Moccasin Wallow Road in Palmetto, Manatee County, Florida. The authorization was issued on October 27, 2020, for DEP Incident #2020-4I-66518 with an incident date of October 27, 2020, under the direction of On-Scene Coordinator Jamie Arleo.
The scope of work includes spill response and soil removal services resulting from a vehicle accident that released approximately 20 gallons of motor oil onto the roadway and soil with a large puddle of free product on-site and impact to a small creek. The work authorization includes one supervisor, three recovery technicians, and specialized equipment including a response trailer, four 55-gallon drums, oil dry absorbent material, and work clothes. The contractor is authorized to excavate contaminated soil drums for transport to Cedar Trails Landfill for disposal. The work assignment is established as a fixed price authorization with a not-to-exceed estimate of $10,000. Funding is allocated from Project Number LE810, Organization Code 370401000000, Object Code 139900, and Fund Category 099001 (101492) for the fiscal year. The work authorization was approved on November 2, 2020, by DEP Representative Jamie Arleo, Contractor Representative Michael Bevacqua, and OER Budget Representative Kristin Gousse.
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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. 2020-4I-66518
LE810 Mike Bevacqua 10/27/20
Jamie Arleo
US Hwy 41 & Moccasin Wallow Rd 813-470-5923
Palmetto Manatee 813-267-3561
10/27/20 @ 12:00 PM
20-gals of motor oil spilled onto the roadway and soil from a vehicle accident. Large puddle of free product on-site. Small creek impacted by the release.
work clothes
Response Trailer oil dry
Several drums of contaminated soil will need to be excavated at the site. Drums will be transported to Cedar Trails Landfill for disposal the following day.
10,000
LE810 37040100000 FC 139900 099001 101492 10000
Jamie Arleo 11/2/20
Michael Bevacqua
Kristin Gousse 11/2/2020
Cory Dilmore
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.11.02 15:30:49 -05'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2020.11.02 11:35:07 -05'00'
Jamie Arleo Digitally signed by Jamie Arleo Date: 2020.11.02 11:21:00 -05'00'
Cory Dewayne Dilmore Digitally signed by Cory Dewayne Dilmore Date: 2020.11.02 14:18:59 -05'00'
File details come from the government source that posted it. Updated .