CN-370000-LE810-8I-69302.pdf
PDF 130 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 (OER), authorizing emergency spill response services. The contractor is Hulls Environmental, with incident representation by Larry Hall. The incident occurred on July 22, 2022, in Sneads, Cross City, Dixie County, Florida, at coordinates 29°40'36.0"N 83°14'52.9"W on State Road 19 Southbound, under DEP Incident #2022-8I-69302.
The work involves immediate spill response services for 75 gallons of diesel fuel spilled into water and debris held in a roadside ditch. Services include deployment of a vacuum truck and absorbents to remove contaminated materials, with traffic management and lane closure on the roadway. The work is classified as non-hazardous waste disposal (diesel-contaminated) and is assigned a fixed-price contract value of $12,000. Personnel deployed include a supervisor, recovery technician, and equipment operator; equipment includes a vacuum truck, pickup/van, and personal protective equipment at Level D. Funding is allocated from Project LE810, Organization Code 37040100000, Object Code 139900, Fund Category 099001, and Account 101492. All required signatures from the DEP Representative (Melissa Woehle), Contractor Representative (Larry Hall), and OER Budget Representative (Amanda Lanphere) were executed between July 29 and August 3, 2022.
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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
Hulls Environmental 2022-8I-69302
LE810 Larry Hall 7/22/22
Sneads Transport diesel spill Melissa Woehle
29°40'36.0"N 83°14'52.9"W (SR 19 SB) 850-245-2873
Cross City Dixie 850-363-3695
Monday, 8/1/22
75 gallons of diesel spilled into water held in roadside ditch.
work clothes/level D
Use vacuum truck and absorbents to remove diesel from water and debris in roadside ditch. MOT lane closure needed.
12,000
LE810 37040100000 FC 139900 099001 101492 12,000 00
Melissa Woehle 07/29/2022
Larry Hall 07/29/2022
Amanda Lanphere 08/03/2022
Samuel Graves
Non-haz (diesel contaminated)
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.08.03 14:22:31 -04'00'
Larry Hall Digitally signed by Larry Hall Date: 2022.07.29 13:30:04 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2022.07.29 12:21:09 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.08.02 17:12:52 -04'00'
File details come from the government source that posted it. Updated .