CN-370000-LE810-4I-66680.pdf
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- Contract number
- LE810
- Issued by
- Florida
About this file
This document 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). The form authorizes work to be performed by Hull's Environmental Services, Inc. under Contract No. LE810. The incident, designated as DEP Incident #2020-4I-66680, occurred on December 10, 2020, in the Chancey Road area of Riverview, Hillsborough County, with Jamie Arleo serving as the On-Scene Coordinator.
The work authorization covers spill response and removal services for approximately 15 gallons of oil that spilled into a drainage ditch with surface water. The scope of work includes overpack drums, transport of drums to a Treatment Storage and Disposal Facility (TSDF), disposal of (4) 5-gallon abandoned drums, and handling of contaminated materials. The contractor will deploy one supervisor and one recovery technician utilizing a pickup or van, along with Visqueen, absorbent boom and pads, and appropriate PPE including work clothes with rubber boots. Analytical and disposal arrangements will be managed via the contractor. The work is authorized as a fixed-price assignment with a not-to-exceed estimate of $10,000. Funding is allocated from Project No. LE810, Organization Code 37040100000, Object Code 139900, Fund Category 099001, with authorization number 101492. The work authorization was executed and approved by all required parties on December 16, 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, Inc. 2020-4I-66680
LE810 Mike Bevacqua 12/10/20
Jamie Arleo
Chancey Road 813-470-5923
Riverview Hillsborough 813-267-3561
12/11/20
15-gals of oil spilled into a drainage ditch with surface water.
work clothes w/ rubber boots
Boom & Pads
Absorbent pads will be used to recover floating oil on surface water. Absorbent Boom will be left in place. Hull's will handle disposal of contaminated pads and buckets of oil.
$10,000
LE810 37040100000 FC 139900 099001 101492 10000
Jamie Arleo 12/10/20
Michael Bevacqua 12/16/2020
Kristin Gousse 12/16/2020
Melissa Woehle
✔ (4) 5-gal
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.12.16 10:05:38 -05'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2020.12.16 07:42:46 -05'00'
Jamie Arleo Digitally signed by Jamie Arleo Date: 2020.12.14 16:05:46 -05'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.12.16 10:08:38 -05'00'
File details come from the government source that posted it. Updated .