CN-370000-LE810-4I-67294.pdf
PDF 131 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), for emergency spill response services. The form authorizes work by Hull's Environmental Services, Inc. under Contract LE810 for an incident occurring on March 29, 2021, at SR-64 and Dam Road in Bradenton, Manatee County. The incident was overseen by Jamie Arleo as the On-Scene Coordinator, with Mike Bevacqua serving as the contractor representative and Kristin Gousse as the OER Budget Representative.
The authorization covers spill response and soil removal services for approximately 100 gallons of diesel fuel and 10 gallons of motor oil released into a wetlands area. The scope of work includes vacuum truck operations to remove free product from a stormwater ditch, deployment of sorbent pads and boom, excavation with surface and groundwater removal, and potential sampling of surface and groundwater. The contractor's level of effort includes one supervisor, three recovery technicians, one equipment operator, and one response trailer, along with a response truck, vacuum truck, backhoe, three roll-off containers, and a roll-off liner. The work assignment is established as a fixed price authorization with a not-to-exceed estimate of $20,000, funded through Project LE810 (Fund Category/Year 101492) with analytical and disposal arrangements handled via the contractor. All required approvals were digitally executed on March 30, 2021.
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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. 2021-4I-67294
LE810 Mike Bevacqua 03/29/21
Jamie Arleo
SR-64 and Dam Rd 813-470-5923
Bradenton Manatee 813-267-3561
Approximately 100-gals of diesel fuel and 10-gals of motor oil released into a wetlands area.
3 3
1 work clothes
Response Trailer roll-off liner
Vacuum truck will used to remove free product from stormwater ditch. Sorbent pads/boom deployed. Excavation will be required with removal of surface/groundwater.
MOT could be required for excavation. Sampling of surface/groundwater could be required.
20,000
LE810 37040100000 FC 139900 099001 101492 20000
Jamie Arleo 03/30/21
Mike Bevacqua 3/30/21
Kristin Gousse 3/30/21
Cory Dilmore
Kristin Gousse Digitally signed by Kristin Gousse Date: 2021.03.30 16:43:27 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2021.03.30 14:36:17 -04'00'
Jamie Arleo Digitally signed by Jamie Arleo Date: 2021.03.30 09:21:13 -04'00'
Cory Dewayne Dilmore Digitally signed by Cory Dewayne Dilmore Date: 2021.03.30 16:12:19 -04'00'
File details come from the government source that posted it. Updated .