CN-370000-LE810-4I67636C.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 (OER). The document authorizes work to be performed by Hull's Environmental under contract number 2021-4I-67636C at a site in Tampa, Hillsborough County, Florida. The incident involved used motor oil dumping on county right-of-way and was assigned DEP Incident #2021-4I-67636C with an incident date of May 27, 2021. The On-Scene Coordinator (OSC) was Domenic LetoBarone, and the DEP representative was Mike Bevacqua.
The authorized work involves spill response and soil remediation services with an estimated cost of $10,000.00, structured as a fixed-price contract. The scope of work includes using a mini-excavator and Vac-Con equipment to remove approximately 25+ gallons of used motor oil and impacted soil and gravel from the site adjacent to the Old Castle building near a TECO gas transmission line. The work requires one supervisor, two recovery technicians, one equipment operator, and one truck driver, along with specified equipment including a response truck, vacuum truck, pickup/van, backhoe, and roll-off containers. Analytical and disposal arrangements were handled via the contractor, with contaminated materials profiled as used oil-impacted soils. The funding was sourced from Project LE810, Organization Code 37040100000, with approval signatures obtained from all required parties by June 3, 2021.
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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 2021-4I-67636C
LE810 Mike Bevacqua 5/27/2021
Used Motor Oil Dumping on County R.O.W. Domenic LetoBarone
East Skagway Ave. at North 10th Street 813-470-5920
Tampa Hillsborough 813-299-3608
Please call to coordinate estimated 25+ gallons of used motor oil dumped onto County R.O.W. adjacent to the Old Castle building
2 1
1 Work Clothes
Truck Driver Vac Con & Roll-off Truck
Please bring cones and signs. Use a mini-excavator and shovels to loosen oil impacted gravel and soil and remove with a Vac-Con. A roll-off truck and box may be needed to empty the contents of the Vac-Con. A TECO gas transmission line is within the impacted soils. Backfill and sod the excavation to prevent soil washout and structural erosion.
10,000.00
LE810 37040100000 JC 139900 212001 104132 10000 00
Domenic LetoBarone 5/29/2021
Mike Bevacqua 5/29/2021
Kristin Gousse 6/3/2021
Cory Dilmore
Used oil impacted soils
Use a mini-excavator & Vac-Con to remove impacted soils. Gas line in area
Kristin Gousse Digitally signed by Kristin Gousse Date: 2021.06.03 08:53:59 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2021.06.03 07:52:49 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2021.05.29 20:25:18 -04'00'
Cory Dewayne Dilmore Digitally signed by Cory Dewayne Dilmore Date: 2021.06.03 08:44:18 -04'00'
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