CN-370000-LE810-4I-69245.pdf
PDF 144 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 Hulls Environmental Services to perform emergency response work related to a motor oil spill incident at 4413 N Thatcher Ave in Tampa, Hillsborough County, Florida. The incident, assigned DEP Incident #2022-4I-69245Z, was reported on July 16, 2022, with Michelle Davidson designated as the On-Scene Coordinator. The authorization was executed and signed by representatives from both the contractor and DEP on July 18-19, 2022.
The work involves cleanup of a 75-yard-long ditch filled with motor oil, utilizing spill response and soil removal procedures. The contractor mobilized absorbent materials and booms on July 16, 2022, with equipment maintenance and switching scheduled for July 18, 2022, pending permits and authorizations before full cleanup completion. The Level of Effort includes one supervisor and two recovery technicians, with a response truck and work clothes designated as equipment. Analytical and disposal arrangements are to be handled via the contractor. The work is assigned as a fixed-price contract with a not-to-exceed estimate of $15,000. Funding is allocated from Project No. LE810, Organization Code 3704010000, EO FC, Object Code 139900, Fund Category 099001, and Category/Year 101492, with the full amount of $15,000 approved by Samuel Graves, Amanda Lanphere, and Michelle Davidson on July 19, 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
Hulls Environmental Services 2022-4I-69245Z
LE810 Mike Bevacqua 07/16/2022
Thatcher Ave Oil Spill Michelle Davidson
4413 N Thatcher Ave 813-470-5920
Tampa Hillsborough 813-299-3608
75 Yard long ditch filled with motor oil that needs to be cleaned up.
work clothes
The use of absorbent materials and booms was needed on 07/16/22. On 07/18/22, booms and pads are being switched out. After permits and certain authorizations are made, full clean up with be completed.
15,000
LE810 37040100000 FC 139900 099001 101492 15000 00
Michelle Davidson 07/18/2022
Michael Bevacqua 7/18/2022
Amanda Lanphere 07/19/2022
Samuel Graves
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2022.07.18 15:05:58 -04'00'
Michelle Davidson Digitally signed by Michelle Davidson Date: 2022.07.18 10:26:36 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.07.19 07:55:45 -04'00'
File details come from the government source that posted it. Updated .