CN-370000-LE810-4I-68558.pdf
PDF 208 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, Office of Emergency Response. The document authorizes work performed by Hull's Environmental under Contract LE810 for incident 2022-4I-68558. The incident occurred on January 10, 2022, at Mile Marker 52 on Interstate 4 in Haines City, Polk County, Florida. Key personnel involved include Ben Skidmore as the contractor representative, Melissa Woehle as the DEP representative, and Amanda Lanphere as the OER Budget representative.
The authorized work involves emergency spill response and soil removal services resulting from a vehicle accident that released diesel and coolant. The scope of work includes excavation of impacted soil, disposal of contaminated materials, and arrangement of permits and traffic management. The contractor will conduct analytical and disposal arrangements, profiling the waste as diesel and coolant contaminated soil. The work authorization is structured as a fixed-price contract with a not-to-exceed amount of $20,500. Funding is allocated from Project LE810, Organization Code 37040100000, with Object Code 139900, Fund 212001, and Category/Year 101492. All required signatures were executed on June 8, 2022.
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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 2022-4I-68558
LE810 Ben Skidmore 1/10/2022
Hains City Spill
Mile Marker 52 on I-4
Haines City Polk diesel and coolant from a vehicle accident work clothes
Excavate impacted soil, disposal, arrange permits and M.O.T.
20,500
LE810 37040100000 FC 139900 212001 101492 20500 00
Melissa Woehle 6/8/22
Amanda Lanphere 06/08/2022
Samuel Graves diesel and coolant contaminated soil
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.06.08 16:14:14 -04'00'
Ben Skidmore Digitally signed by Ben Skidmore DN: cn=Ben Skidmore gn=Ben Skidmore c=US United States l=US United States o=Hull's Environmental Services.
e=bskidmore@hullsenv.com Reason: I am the author of this document Location:
Date: 2022-06-08 15:49-04:00
Melissa Woehle Digitally signed by Melissa Woehle Date: 2022.06.08 15:05:45 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.06.08 16:02:13 -04'00' skidmore2151@gmail.com Typewritten text Ben Skidmore skidmore2151@gmail.com Typewritten text 6-8-22
File details come from the government source that posted it. Updated .