CN-370000-LE810-4I-70818.pdf
PDF 161 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response on January 31, 2024. The authorization involves Hull's Environmental Services as the contractor, with representatives Mike Bevacqua (contractor) and Jon Belcher (FDEP On-Scene Coordinator). The work is being performed at 802 E Wilder Ave, Tampa, Hillsborough County, Florida, and is associated with DEP Incident #2024-4I-70818.
The work involves spill response and removal of soil related to an abandoned drum containing 2 fifty-five gallon drums of used oil in a 250-gallon tote with debris. The scope includes transporting drums to a Treatment, Storage, and Disposal Facility (TSDF) and testing waste for TCLP compliance. The authorization allocates 1 supervisor, 2 recovery technicians, response and straight trucks, 2 overpack drums, 2 fifty-five gallon drums, visqueen sheeting, and PPE Level D equipment. The work is authorized under a fixed-price arrangement with a not-to-exceed estimate of $5,000. Funding is provided through Project LE810, Organization Code 3704 0100 000, with Object Code 131545, Fund 0990001, and Category/Year 102577. The authorization was approved by FDEP Representative Jon Belcher on January 31, 2024, contractor representative Mike Bevacqua on February 1, 2024, and OER Budget Representative Vickie Koenig on March 6, 2024.
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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 2024-4I-70818
LE810 Mike Bevacqua 1/31/2024
Wilder Ave Totes Jon Belcher
802 E Wilder Ave 813-470-5908
Tampa Hillsborough 813-399-0581
(2) 55-gal drums of used oil in a 250 gal tote. Debris in tote.
D
Waste will need to be re-packed and tested for TCLP
5,000
LE810 3704 0100 000 FC 131545 0990001 102577 5,000 00
Jon Belcher
Mike Bevacqua 1/31/2024
Vickie Koenig 3/6/2024
Samuel Graves
✔ 3
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.03.06 16:24:32 -05'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2024.01.31 15:11:22 -05'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2024.02.01 07:09:40 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.03.06 16:04:17 -05'00'
File details come from the government source that posted it. Updated .