CN-370000-LE811-1C-71623.pdf
PDF 162 KB Posted
- Contract number
- LE811
- 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 for emergency response services related to Hurricane Milton. The document authorizes Cliff Berry Inc to perform work under Contract LE 811 in response to incident 2024-1C-71623 (FD097_Hurricane Milton) at 38 Flower Hill Lane, Palm Coast, Flagler County, Florida. The incident occurred on October 13, 2024, with On-Scene Coordinator Brierra T. Mack overseeing the operation.
The work involves the pickup and disposal of two 55-gallon metal drums located at the Hurricane Milton Orphan Drums site. One drum contains 2-butyloctyl 2-hydroxybenzoate (HallBrite BHB), while the contents of the second drum are unknown. The work is classified as an abandoned drum removal with transport to a Treatment Storage and Disposal Facility (TSDF). The scope includes use of personnel (supervisor and recovery technician), vehicles (response truck), and basic equipment, with disposal arrangements handled via the contractor. The work assignment is a fixed-price contract with a not-to-exceed estimate of $3,500. Funding is provided through Project LE 811, Organization Code 3704 0100 000, Object Code 131545, Fund Category/Year 102577, with an authorized amount of $3,500. The work authorization was executed on October 13, 2024, and approved by all required signatories by October 16, 2024.
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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
Cliff Berry Inc 2024-1C-71623 (FD097_Hurricane Milton)
LE811 Bill Cruz 10/13/2024
Hurricane Milton Orphan Drums Brierra T. Mack
38 Flower Hill Lane 904-256-1679
Palm Coast Flagler 904-673-5357
(2) 55-gall on full/75% full drums. One drum contains 2-butyloctyl 2-hydroxybenzoate (HallBrite BHB) and the other is unknown
Hand truck and a truck with a lift to pick up and dispose of two full metal drums. Both drums appear to be in good condition
Suspected contents: Misc. liquid non haz
LE 811 3704 0100 000 FC 131545 099001 102577 3,500 00
Brierra T. Mack 10/13/2024
Yvonne Cerna 10/14/2024
Vickie Koenig 10/16/2024
Samuel Graves
✔ 2
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.10.16 10:32:43 -04'00'
Yvonne Cerna Digitally signed by Yvonne Cerna Date: 2024.10.14 07:45:34 -04'00'
Brierra Mack Digitally signed by Brierra Mack Date: 2024.10.13 18:54:40 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.10.16 10:20:28 -04'00'
File details come from the government source that posted it. Updated .