CN-370000-LE810-7I-65923.pdf
PDF 237 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 (DEP), Office of Emergency Response (OER). The document authorizes work to be performed by Hull's Environmental Services, Inc. under existing contract LE810. The incident involved Onel Family Trucking and occurred on June 24, 2020, near Interstate 95 South at mile marker 187 in Melbourne, Brevard County, Florida. Helena Dacenay served as the On-Scene Coordinator (OSC) for the DEP.
The work authorization covers soil excavation, refill, and confirmatory sample analysis related to a 100-gallon diesel fuel spill to soil. The scope of work is classified as a fixed-price assignment with a not-to-exceed amount of $20,000. Authorized resources include two Recovery Technicians, three Equipment Operators, one Pickup or Van, one Backhoe or Similar equipment, one Roll-off Container, a Vapor Detector, and PPE Level D equipment. The work was profiled as non-hazardous petroleum contaminated waste with analytical and disposal arrangements handled via the contractor. The authorization was approved on July 15, 2020, with funding sourced from Project No. LE810, Organization Code 37040100000, Object Code 139900, Fund Category 099001, and Category/Year 101492.
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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
Beb Skidmore 8-25-2020
Hull's Environmental Services, Inc. 2020-7I-65923
LE810 Ben Skidmore 06/24/2020
Onel Family Trucking Diesel Spill Helena Dacenay
Interstate 95 South, near mile marker 187 407-897-4342
Melbourne Brevard 407-448-1266
Helena Dacenay
100 gallons diesel fuel to soil
2 1
3 D
Scope of work will involve soil excavation, refill, and confirmatory sample analysis by contractor under LE810 rates. Work may be required to be completed at night dependent on FDOT permit issued.
20,000
Helena Dacenay 7/14/20
Melissa Woehle
✔ Non-Hazardous petroleum contaminated waste
Disposal of contaminated material
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: 2020-08-25 12:22-04:00
Helena Ochoa Dacenay Digitally signed by Helena Ochoa Dacenay Date: 2020.07.14 13:52:22 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.07.15 10:16:03 -04'00'
LE810 37040100000 FC 139900 099001 101492 20000
Kristin Gousse 9/23/20
File details come from the government source that posted it. Updated .