CN-370000-LE810-8I-65950.pdf
PDF 232 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's Office of Emergency Response on July 2, 2020. The form authorizes work under contract 2020-8I-65950 with Hull's Environmental Services, with Larry Hall serving as the contractor representative. The incident, designated MM269 I10 - Peterson Sink, occurred in Madison County at the I10 EB shoulder location, with Heather Perkins serving as the On-Scene Coordinator.
The work authorization addresses a petroleum contamination emergency involving 200 gallons of diesel in soil and standing water adjacent to Peterson Sink. Hull's Environmental Services is authorized to respond immediately to remove diesel from the water surface and secure the site for subsequent soil removal. The contractor will manage line locates, DOT permit applications, and traffic management as needed. The fixed-price contract amount is $5,500.00, with additional costs for traffic management, if required, and disposal of contaminated water and soil billed on a cost-plus basis. The work is funded through project number LE810, organization code 37040100000, and charged to fund category/year 101492. All required signatures from the DEP representative, contractor representative, and OER budget representative were obtained between July 10 and July 13, 2020.
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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 2020-8I-65950
LE810 Larry Hall July 2, 2020
MM269 I10 - Peterson Sink Heather Perkins
MM269 I10 EB shoulder (850) 245-2869
Madison Madison (850) 251-1475
200-gallon diesel in soil and standing water adjacent to Peterson Sink.
Work Clothes abs boom & pads
Respond immediately to remove diesel from water surface and secure site for soil removal at a later date. Hull's will handle line locates, DOT permit application and MOT if needed.
MOT, if needed, and disposal of contaminated water and soil will be cost plus.
5,500.00
LE810 37040100000 FC 139900 099001 101492 5500
Heather A. Perkins 7/10/20
Larry Hall 7/10/20
Kristin Gousse 7/13/2020
Melissa Woehle
Petroleum contaminated
Kristin Gousse Digitally signed by Kristin Gousse Date: 2020.07.13 10:01:44 -04'00'
Larry Hall Digitally signed by Larry Hall Date: 2020.07.10 11:51:59 -04'00'
Heather A. Perkins Digitally signed by Heather A. Perkins Date: 2020.07.10 09:03:38 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2020.07.10 12:54:25 -04'00'
File details come from the government source that posted it. Updated .