CN-370000-LE810-4I66215Z.pdf
PDF 232 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection's Office of Emergency Response. The document authorizes work to be performed by Hulls Environmental under Contract LE810 in response to a spill incident (DEP Incident #2020-4I-66215Z) that occurred on September 15, 2020, at Sagasta Street and South 23rd Street in Tampa, Hillsborough County. The incident involved approximately 10 gallons of oil dumped into a waterway in a ditch. Jordan Luscier served as the On-Scene Coordinator, with Mike Bevacqua representing the contractor.
The contracted work includes spill response and soil removal services with an authorization amount of $10,000, categorized as a fixed-price work assignment. Hulls Environmental's scope includes site inspection, utility locates, road permits, excavation using a Gradall Excavator, disposal of contaminated soil and media, and mobilization of traffic (MOT). The level of effort specified includes one supervisor, two recovery technicians, and one equipment operator, along with a response truck, one lined roll-off truck, one 55-gallon drum, one roll-off container, and Level D PPE. Funding is allocated from Project LE810 under Organization Code 37040100000, Object Code 139900, and Fund Category 099001 (101492). All required signatures were obtained between September 16 and October 5, 2020, from the DEP representative, contractor representative, and OER budget representative.
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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 2020-4I-66215Z
LE810 Mike Bevacqua 9/15/20
Oil dumping on Sagasta Jordan Luscier
Sagasta St and S 23rd 813-267-3521
Tampa Hillsborough 813-267-3521
Call to schedule
10 gallons of oil dumped into the waterway in the ditch.
2 1
1 Level D
1 Lined roll-off truck
Hulls will inspect the site, have utility locates performed, and complete any required road permits. Hulls will arrange for the following: disposal of the contaminated soil/PC/media, and required MOT.
Gradall Excavator.
10,000
LE810 37040100000 FC 139900 099001 101492 10000
Jordan Luscier 9/16/20
Mike Bevacqua 9/16/20
Kristin Gousse 10/05/2020
Melissa Woehle
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.10.05 12:55:16 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2020.09.17 14:10:04 -04'00'
Jordan Luscier Digitally signed by Jordan Luscier Date: 2020.09.16 19:44:37 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.10.02 14:41:13 -04'00'
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