CN-370000-LE810-4I69055C.pdf
PDF 132 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
Work Authorization Form Summary
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 (OER), for work performed by Hull's Environmental under Contract #LE810. The authorization was issued on May 26, 2022, in response to DEP Incident #2022-4I-69055C, a criminal case involving property located on Endsley Road in Brooksville, Hernando County, Florida. The incident was reported on May 26, 2022, with Domenic LetoBarone serving as the On-Scene Coordinator.
The scope of work includes criminal sampling and excavation of buried construction and demolition (C&D) materials and unknown debris from a 1970s-era mobile home, with possible asbestos contamination. The work encompasses unearthing buried debris while maintaining scene control to prevent asbestos-related material from becoming airborne, with OER personnel collecting samples with assistance from Recovery Technicians in Level B personal protective equipment. The authorization specifies a fixed-price contract amount of $7,000.00, funded through project number LE810, organization code 37040100000, with funding categorized under FC 139900, object code 099001, and fund category 101492. Equipment and personnel required include one supervisor, two recovery technicians, two equipment operators, a response truck, pickup or van, backhoe or similar equipment, visqueen, 55-gallon drums, water truck with spray capability, and Level B PPE. Disposal of impacted PPE and visqueen was arranged through the contractor.
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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 2022-4I-69055C
LE810 Mike Bevacqua 5/26/2022
* CRIMINAL CASE * Domenic LetoBarone
Endsley Road 813-470-5735
Brooksville Hernando 813-625-7636
Please call for further details
Suspected 1970's mobile home / C&D / buried material. Possible asbestos present in buried materials referencing date of build.
2 B
Water truck with spray
The scope of work is to unearth the buried debris, and control the scene as to not let any possible asbestos related material become airborne. OER will collect samples with the assistance of the Recovery Techs while in Level B PPE. Appropriate decon should be set up and disposal of impacted PPE/visqueen arranged.
7,000.00
LE810 37040100000 FC 139900 099001 101492 7000 00
Domenic LetoBarone 5/22/2022
Mike Bevacqua 5/23/2022
Amanda Lanphere 5/26/2022
Samuel Graves possible asbestos related PPE/Visqueen
Criminal Sampling and excavation of buried C&D and unknown material
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.05.26 11:37:08 -04'00'
Michael Bevacqua Digitally signed by Michael Bevacqua Date: 2022.05.23 11:58:12 -04'00'
Domenic LetoBarone Digitally signed by Domenic LetoBarone Date: 2022.05.22 21:26:11 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.05.26 11:33:04 -04'00'
File details come from the government source that posted it. Updated .