CN-370000-LE810-5I-73057.pdf
PDF 162 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection (FDEP) Office of Emergency Response. The document authorizes Hull's Environmental Services to perform emergency response work under Contract LE810, with DEP Incident #2025-5I-73057. The incident occurred on August 8, 2025, at E Chestnut Ave, Crestview, Florida 32539, located in Okaloosa County. The On-Scene Coordinator (OSC) is Stephanie Kindos, who can be reached at 850-767-0052 (office) or 850-210-5945 (cell). The work must be completed by September 8, 2025.
The work includes spill response and removal of soil containing an estimated 50 gallons of diesel fuel. The scope encompasses sampling and transport of drums to the Treatment Storage and Disposal Facility (TSDF). Hull's Environmental Services will provide one supervisor, two recovery technicians, and one field chemist, along with response equipment including a response truck, pickup/van, backhoe, two roll-off containers, vapor detector, and personal protective equipment (PPE) Level D. The profiled waste is classified as petroleum contaminated soil, non-hazardous. The work assignment is structured as a fixed-price contract with a not-to-exceed amount of $17,000. Funding is allocated from Project LE 810, Organization Code 37040100000, with the amount charged to Object Code 131545, Fund Category 099001, Account 101492. Approvals were executed by DEP Representative Stephanie Kindos (8-26-25), Contractor Representative Christina Hiers (8-25-25), and OER Budget Representative Beth McNeil (08-27-2025).
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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 Services 2025-5I-73057
LE810 Jesse Hixson 8-8-25
30.75091258 x -86.53974194 Stephanie Kindos
E Chestnut Ave, Crestview FL, 32539 850-767-0052
Crestview Okaloosa 850-210-5945
By 9-8-25
Diesel, 50 gallons
2 2
D
PID/OVA
17,000
LE 810 37040100000 FC 131545 099001 101492 $17,000
Stephanie Kindos 8-26-25
Christina Hiers 8/25/25
Beth McNeil 08/27/2025
Smuel Graves
✔ petroleum contaminated soil, non hazardous
Emergency Response Action per 62-780.500 F.A.C.
Beth McNeil Digitally signed by Beth McNeil Date: 2025.08.27 07:59:36 -04'00'
Christina Hiers Digitally signed by Christina Hiers DN: cn=Christina Hiers gn=Christina Hiers c=US United States l=US United States o=Hull's Environmental Services ou=PC Office e=chiers@hullsenvironmental.com Reason: I am the author of this document Location:
Date: 2025-08-25 08:12-05:00
Stephanie Kindos Digitally signed by Stephanie Kindos Date: 2025.08.26 14:41:31 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.08.26 16:05:14 -04'00'
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