CN-370000-LE810-4I65935C.pdf
PDF 132 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 (FDEP), Office of Emergency Response, authorizing work to be performed by Hull's Environmental under Contract LE810. The form documents emergency response activities related to DEP Incident #2020-4I-65935C, occurring on June 25, 2020, at the City of Tampa Right-of-Way near 8501 N. Brooks Street in Hillsborough County. The on-scene coordinator is Domenic LetoBarone, and the form was executed by representatives from Hull's Environmental, FDEP, and the OER budget office.
The work involves excavation and remediation of approximately 25 x 8 x 2 feet of gasoline-impacted soil resulting from an illegal dumping of approximately 15 gallons of used gasoline. The scope includes soil excavation into a roll-off container, transportation to a licensed disposal facility, collection of a confirmatory closure sample for analysis, backfill, and sodding of the excavation area. The work is authorized as a fixed-price contract with a not-to-exceed amount of $8,500.00, with funding charged to Project LE810, Organization Code 370401000000, Object Code 1339900, and Fund Category 099001 for fiscal year 101492. The contractor is responsible for providing one supervisor, one recovery technician, one equipment operator, one pickup/van, one backhoe or similar equipment, and one roll-off container, along with traffic control signage and materials handling equipment.
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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 2020-4I-65935C
LE810 Mike Bevacqua 6/25/2020
Gasoline Dumping - 5G's Logistics Domenic LetoBarone
City of Tampa Right-of-Way near 8501 N. Brooks Street 813-470-5920
Tampa Hillsborough 813-299-3608
Please set fro next week (Thursday or Friday)
~ 15-gallons of used gasoline was illegally dumped on City Right-of-Way on 6/25/2020
1 1
1 D
Roll-off Truck/Box
The gasoline impacted area is ~ 25 x 8 x 2. Call in utility locates. Excavate contaminated soils into a roll-off box, transport for disposal, collect a confirmatory closure sample, backfill, and sod excavation. Please bring traffic cones and 2 work zone signs.
8,500.00
LE810 37040100000 FC 1339900 099001 101492 8500
Domenic LetoBarone 7/2/2020
Michael Bevacqua 7/2/2020
Kristin Gousse 7/10/2020
Melissa Woehle gasoline impacted soils
Excavate contaminated soils, collect a confirmatory sample, backfill, & sod
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.07.10 14:01:43 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2020.07.02 10:20:42 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2020.07.09 19:20:20 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.07.10 13:02:36 -04'00'
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