CN-370000-LE810-8I-73595.pdf

PDF 585 KB Posted

Attached to
Master Agreement FL|LE810|80305ce879d8c199b19c664916df36dc
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 (FDEP), Office of Emergency Response (OER). The form authorizes emergency response work performed by Hull's Environmental Services under Contract LE 810. The authorization covers incident 2026-81-73595, which occurred on 03/11/2026 at an I-10 EB location in Madison County near a DOT weigh station. The OSC (On-Scene Coordinator) is Melissa Woehle.

The authorized work includes spill response, soil removal, and sampling activities related to approximately 100 gallons of diesel fuel contamination. The response involves personnel (supervisor, recovery technician, field chemist, and equipment operator), vehicles (response truck, pickup/van, and backhoe), and equipment (roll-off containers, vapor detector, and PPE). Analytical and disposal services will be conducted by the contractor, with wastes profiled as petroleum contaminated. The work is assigned as a fixed price contract with a not-to-exceed estimate of $18,000. Funding is authorized through Project LE 810, Organization Code 3704 0100 000, Object Code 131545, Fund 099001, and Category 101492 for $18,000.00. The work authorization was executed and approved on 5/4/2026 by FDEP Representative Melissa Woehle, Contractor Representative Scott Fullerton, and OER Budget Representative Vickie Koenig.

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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

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