CN-370000-LE810-4I-68895.pdf
PDF 94 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection's Office of Emergency Response and authorizes Hull's Environmental to perform emergency response services. The form documents the authorization for work related to DEP Incident #2022-4I-68895, dated April 8, 2022, at the Hillsborough Abandoned Buckets site located at 6330 Jensen Road in Tampa, Hillsborough County. The Onscene Coordinator (OSC) is Johnathon Fabrizio, with approval signatures obtained from DEP Representative Johnathon Fabrizio, Contractor Representative Michael Bevacqua, and OER Budget Representative Amanda Lanphere on April 18-22, 2022.
The work scope includes spill response, removal of soil, overpack drums using a roll-off truck, and management of 28 five-gallon buckets containing used oil and motor oil. Hull's Environmental will perform site inspection, arrange utility locates, complete required road permits, and coordinate disposal of contaminated soil and required management of transport (MOT). The work is authorized as a fixed-price assignment with a not-to-exceed estimate of $15,000. Analytical and disposal arrangements will be handled via the contractor. Funding is provided through project LE 810 with organization code 37040100000, object code 139900, fund category 099001, and category/year 101492, with the full authorized amount of $15,000.00.
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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-68895
LE810 Mike Bevacqua 4/08/22
Hillsborough Abandoned Buckets Johnathon Fabrizio
6330 Jensen Road 813-267-3561
Tampa Hillsborough 813-267-3561
Please call cell to coordinate operational date/time.
Used Oil/ Motor Oil
Roll off truck
Hulls will inspect the site, have utility locates performed, and complete any required road permits. Hulls will arrange for the disposal of the contaminated soil and required MOT.
15,000
LE 810 37040100000 FC 139900 099001 101492 15,000 00
Johnathon Fabrizio 4/18/2022
Michael Bevacqua 4/18/2022
Amanda Lanphere 4/22/2022
Sam Graves
(28) 5-gallon buckets
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.04.22 10:41:18 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2022.04.18 13:55:13 -04'00'
Johnathon Fabrizio Digitally signed by Johnathon Fabrizio Date: 2022.04.18 13:36:20 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.04.19 09:32:43 -04'00'
File details come from the government source that posted it. Updated .