CN-370000-LE810-4I66320Z.pdf
PDF 232 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
Document Summary
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection, Office of Emergency Response, authorizing Hulls Environmental to perform emergency spill response work under Contract LE810. The work addresses an oil dumping incident (DEP Incident #2020-4I-66320Z) that occurred on September 15, 2020, at 4787 Hartford Street in Tampa, Hillsborough County, Florida. The incident involved approximately 10 gallons of oil dumped into a waterway in a ditch along a city right-of-way. The Onsite Coordinator is Jordan Luscier, and the incident was reported by Mike Bevacqua.
Hulls Environmental's scope of work includes site inspection, utility locate coordination, completion of required road permits, disposal of contaminated soil and media, and traffic management oversight. The contractor will deploy one supervisor, three recovery technicians, and one equipment operator, utilizing one response truck, one Gradall excavator, one 55-gallon drum, one lined roll-off container truck, and appropriate Level D personal protective equipment. The work is classified as fixed-price with a not-to-exceed authorization amount of $10,000. Analytical and disposal arrangements will be managed by the contractor. Funding is allocated from Project LE810, Organization Code 37040100000, Object Code 139900, Fund Category 099001, with cost reference 102577. The work authorization was approved on September 16 and 22, 2020, by 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-66320Z
LE810 Mike Bevacqua 9/15/20
Oil dumping on city ROW Jordan Luscier
4787 Hartford St 813-267-3521
Tampa Hillsborough 813-267-3521
10 gallons of oil dumped into the waterway in the ditch.
3 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 FL 139900 099001 102577 10000
Jordan Luscier 9/16/20
Mike Bevacqua 9/16/20
Kristin Gousse 9/22/20
Melissa Woehle
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.09.22 13:10:19 -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: 2020.09.22 04:21:28 -04'00'
File details come from the government source that posted it. Updated .