CN-370000-LE810-4I66490C.pdf
PDF 131 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, Effective 7-01-2017) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response. The form authorizes Hull's Environmental Services to perform emergency response work under Contract LE810 for DEP Incident #2020-4I-66490C. The incident involved used motor oil dumping at Lake Mariana, located at the Canal behind 2026 Thelma Drive in Auburndale, Polk County, Florida. The Incident Safety Commandant was Domenic LetoBarone, with Ben Skidmore serving as the contractor representative and an incident date of October 21, 2020.
The authorized work consists of spill response services with an estimated cost of $8,000.00 on a fixed-price basis. The scope includes deploying personnel (1 supervisor and 2 recovery technicians), operating a vacuum truck and pickup vehicle to collect approximately 5 gallons of used motor oil contaminated debris, and utilizing a response trailer and additional containment boom. The work also includes transport of drums to the Treatment, Storage, and Disposal Facility (TSDF). Analytical and disposal services are being provided via the contractor, with waste profiled as used oil contaminated debris and oily water. Funding is allocated from Project LE810, Organization Code 37040100000, Object Code 139900, Fund 212001, and Category/Year 104132. The form was approved by FDEP representatives Melissa Woehle, Domenic LetoBarone, and OER Budget Representative Kristin Gousse on October 23, 2020.
View the file
Other files
Show 40 more
50 files listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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-66490C
LE810 Ben Skidmore 10/21/2020 used motor oil dumping - Lake Mariana Domenic LetoBarone
Canal behind 2026 Thelma Drive 813-299-3608
Auburndale Polk 813-299-3608
Respond immediately
< 5-gallons of used motor oil dumped into a waterway that leads to Lake Marianna
1 Work Clothes - Level D
Response Trailer
Use leaf blowers and a vacuum truck to collect the used oil. Deploy additional boom across the canal. Leave boom in place for collection next week.
8,000.00
LE810 37040100000 JC 139900 212001 104132 8000
Domenic LetoBarone 10/22/2020
Ben Skidmore 10/22/2020
Kristin Gousse 10/23/2020
Melissa Woehle used oil contaminated debris, oily water
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.10.23 14:26:13 -04'00'
Ben Skidmore Digitally signed by Ben Skidmore DN: cn=Ben Skidmore gn=Ben Skidmore c=US United States l=US United States o=Hull's Environmental Services ou=Operations e=bskidmore@hullsenv.com Reason: I am the author of this document Location:
Date: 2020-10-23 11:23-04:00
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2020.10.22 15:14:56 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.10.23 13:48:07 -04'00'
File details come from the government source that posted it. Updated .