CN-370000-LE810-4I-69420.pdf
PDF 130 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This Work Authorization Form (WAF) OER_13 is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), to authorize emergency response work by Hull's Environmental Services under Contract LE810. The form documents authorization for immediate response to a petroleum spill incident occurring on August 18, 2022, at Overpass Road and Broadway Avenue in Tampa, Hillsborough County, Florida. The incident was assigned DEP Incident Number 2022-4I-69420 and assigned to On-Scene Coordinator Michelle Davidson.
The work authorization authorizes spill response and soil removal services to address approximately 30 yards of gasoline and diesel contamination in waterway and soil. The scope of work includes deploying one supervisor, two recovery technicians, and one equipment operator, along with response vehicles (response truck, vacuum truck, pickup/van, and backhoe) and equipment (six 55-gallon drums and work clothes for PPE). Analytical and disposal arrangements are to be handled via the contractor. The work is authorized at a fixed price not to exceed $20,000, with funding sourced from Project LE810 (Organization Code 37040100000, EO FC, Object Code 139900, Fund Category 099001, Account 101492). The form was executed and approved by all required parties on September 1-2, 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 Services 2022-4I-69420
LE810 Mike Bevacqua 8/18/22
Overpass Road Petroleum Spill Michelle Davidson
Overpass Rd and Broadway Ave 813-470-5920
Tampa Hillsborough 813-299-3608
30 Yards of Gasoline/Diesel in waterway and soil
1 work clothes
20,000
LE810 37040100000 FC 139900 099001 101492 20,000 00
Michelle Davidson 9/1/22
Michael Bevacqua 9/1/22
Amanda Lanphere 9/2/2022
Samuel Graves
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.09.02 10:18:34 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2022.09.01 13:04:53 -04'00'
Michelle Davidson Digitally signed by Michelle Davidson Date: 2022.09.01 11:06:26 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.09.01 16:39:40 -04'00'
File details come from the government source that posted it. Updated .