CN-370000-LE810-8I72719S.pdf
PDF 163 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, Office of Emergency Response, dated June 25, 2025. The document authorizes work under Contract LE810 between the State of Florida and Hull's Environmental Services, with Jessi Hixson serving as the contractor representative. The incident (2025-8I-72719) involves contamination response at Flat Creek Bridge located at I-10, MM166 EB in Gadsden County, with Melissa Woehle designated as the On-Scene Coordinator.
Hull's Environmental Services is authorized to remove contaminated soil at the specified location, provide proper disposal, implement best management practices to prevent contamination spread and soil erosion, and comply with Department of Transportation permitting requirements. The work includes confirmatory soil sampling for laboratory analysis following excavation in compliance with Florida Administrative Code 72-780. The scope involves 150 gallons of diesel fuel, deployment of personnel (supervisor, recovery technician, and equipment operator), vehicles (pickup/van and backhoe), and equipment including visqueen, roll-off containers, sampling gear (EPA Levels 1 and 2), vapor detector, work clothes/level D PPE, and miscellaneous trailer equipment. The contract is structured as a fixed price authorization with a not-to-exceed estimate of $25,000, funded through Project LE 810, Organization Code 3704 0100 000, Object Code 131545, Fund Category 099001 101492. All required signatures were obtained on June 25-27, 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
Christina Hiers 6/25/25
Hulls 2025-8I-72719
LE810 Jessi Hixson 5/9/2025
Flat Creek Bridge Melissa Woehle
I-10, MM166 EB (outside shoulder, east side of creek) 850-245-2873
Chattahoochee Gadsden 850-363-3695
X
150 gallons diesel trucks and liners work clothes/level D
TBD Trailer, etc. TBD and pre-approved cost
Hull's will provide personnel and equipment to remove contaminated soil at I-10, MM166 EB, provide for proper disposal, use BMPS to prevent spread of contamination and soil erosion and comply with DOT permitting requirements. Confirmatory soil sampling will be collected for lab analysis following the excavation in compliance with 72-780, FAC.
25,000
LE 810 3704 0100 000 FC 131545 099001 101492 25,000 00
Melissa Woehle 6/25/2025
Vickie Koenig 6/27/2025
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.06.27 09:48:40 -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: 2025-06-27 08:15-05:00
Melissa Woehle Digitally signed by Melissa Woehle Date: 2025.06.27 09:42:31 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.06.27 09:51:19 -04'00'
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