CN-370000-LE810-BCESup6.pdf
PDF 129 KB Posted
- Contract number
- RP592
- Issued by
- Florida
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Work Authorization Summary
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection's Office of Emergency Response for emergency response services. The document authorizes work by Hulls Environmental Services, Inc. under Contract LE810 for incident BCE2023 at the Blackjack Creek Oil and Gas Wellfield located southeast of Jay, Florida in Santa Rosa County. The On-Scene Coordinator is Shanin Speas-Frost, with Larry Hall serving as the contractor representative.
The scope of work requires Hulls Environmental Services, Inc. to remove the roof from and cut a door into the East Storage Tank at the Black Creek Energy plant, clean the tank of contaminants, and dispose of contaminated materials as hazardous waste through thermal treatment and dry/stackable material methods as appropriate. The suspected materials involve H2S and containment pollutants/contaminants related to production oil operations. The work is authorized as a fixed-price assignment with a not-to-exceed amount of $999,950.00. Funding is allocated from Project No. BJC23, Organization Code 37357030000, Object Code 139900, and Fund Category 780001 for fiscal year 088502/20. All required signatures were obtained between March 19 and April 2, 2026, including authorization from the DEP Director and the OER Budget Representative.
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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: __________________
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 Services, Inc. BCE2023
LE810 Larry Hall NA
Blackjack Creek Oil and Gas Wellfield (Blackjack Creek) Shanin Speas-Frost southeast of Jay, Florida : (850) 245-8406
Jay Santa Rosa (850) 508-1809 when possible
H2S and containment pollutants/contaminants
Contractor to remove the roof from and cut a door into the East Storage Tank at the Black Creek Energy plant. The Tank will then be cleaned of the contaminant and that contaminated material will be disposed of as a hazardous, thermal treatment and dry/stackable material, as appropriate.
999,950.00
BJC23 37357030000 ZJ 139900 780001 088502/20 $999,950 00
John Coates, Director 4/1/2026
Larry Hall 03/19/2026
Keisha Akhavein 03/25/2026
John Truitt production oil
Keisha Akhavein Digitally signed by Keisha Akhavein Date: 2026.03.25 14:20:33 -04'00'
Larry Hall Digitally signed by Larry Hall Date: 2026.03.19 15:05:30 -04'00'
Digitally signed by John Coates Date: 2026.04.01 17:48:20 -04'00'
John J. Truitt Digitally signed by John J. Truitt Date: 2026.04.02 07:50:03 -04'00' 4/2/2026
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