CN-370000-LE810-4I-68143.pdf
PDF 132 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
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). The document authorizes work by Hull's Environmental under Contract #LE810 for emergency response services related to DEP Incident #2021-4I-68143 occurring on 8/31/2021. The incident was located in Hillsborough County on County R.O.W. near 3901 Trapnell Road in Plant City. The authorized work was coordinated by On-Scene Coordinator (OSC) Domenic LetoBarone and approved by DEP Representative Domenic LetoBarone, Contractor Representative Michael Bevacqua, and OER Budget Representative Precious Boatwright, with final approval by Samuel Graves.
The work authorization covers emergency response to approximately 10 gallons of used motor oil spilled into a roadside ditch with water. Hull's Environmental was authorized to apply containment pads and boom in the ditch, perform utility checks, schedule soil excavation for a later date, and handle disposal, backfill, and sod stabilization as necessary. The Level of Effort included one Supervisor, two Recovery Technicians, and two Equipment Operators, along with response equipment including a response truck, pickup or van, backhoe, and three 55-gallon drums with one roll-off container. The work was assigned as a fixed-price authorization with a not-to-exceed estimate of $12,000, funded through Project No. LE810 (Organization Code 370401000, Object Code 139900) under Fund Category 099001. Analytical and disposal arrangements were designated to be handled via the contractor, with waste profiled as used oil-contaminated soils.
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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 2021-4I-68143
LE810 Mike Bevacqua 8/31/2021
Used oil spill in ditch Domenic LetoBarone
County R.O.W. by 3901 Trapnell Road 813.470.5920
Plant City Hillsborough 813.299.3608
Please call to coordinate cleanup
~ 10-gallons of used motor oil spill in a ditch with water on County R.O.W.
2 1
2 Work Clothes
2 x 5-gallons buckets of used oil spilled into a roadside ditch with water. The Sheriff's Office investigated, there is no known RP. Apply pads and boom in the ditch, schedule soil excavation for a later date, perform utility checks, Hull's will handle disposal, backfill, and sod if necessary to stabilize the slope of the ditch.
12,000
LE810 370401000 FC 139900 099001 101492/00 12,000 00
Domenic LetoBarone 8/31/2021
Michael Bevacqua 9/1/2021
Precious Boatwright
Samuel Graves
Used oil contaminated soils
Precious Boatwright Digitally signed by Precious Boatwright Date: 2021.09.02 10:26:39 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2021.09.01 13:54:46 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2021.09.02 11:03:31 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2021.09.02 13:24:31 -04'00'
File details come from the government source that posted it. Updated .