CN-370000-LE811-1I-71639.pdf
PDF 159 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. The form authorizes work under contract 2024-1I-71639 (FD097) with Cliff Berry, Inc., with Kelly Brandenburg serving as the contractor representative. The incident occurred on October 17, 2024, at 6 Fletcher Court, Palm Coast, Flagler County, Florida. The On-Scene Coordinator is Gracie Brinson. The form was signed by DEP Representative Gracie Brinson on October 18, 2024, Contractor Representative Yvonne Cerna on October 18, 2024, and OER Budget Representative Vickie Koenig on November 12, 2024.
The work involves responding to an abandoned drums incident (2 drums identified) and transporting the drums to a Treatment, Storage, and Disposal Facility (TSDF). The suspected materials consist of a hydrocarbon or solvent-based substance detected by OVA reading of 30ppm. Work activities include one recovery technician and one field chemist using a straight truck and overpack drums (2 units) with PPE Level D/C. The work is assigned as a fixed price contract with a not-to-exceed amount of $5,000. Analytical and disposal arrangements are to be handled via the contractor. Funding is allocated from Project LE 811, Organization Code 3704 0100 000, Object Code 131545, Fund Category 102577, with the full $5,000 budgeted amount.
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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. 2024-1I-71639 (FD097)
811 Kelly Brandenburg 10/17/2024
Fletcher Ct. Gracie Brinson
6 Fletcher Ct. 904-256-1528
Palm Coast Flagler 904-237-6261
Some type of hydro carbon/solvent based on OVA read of 30ppm and test strip.
D/C
The drums appear to be in good condition but the overpack drums are for stand by just in case moving them as is become a problem.
5,000
LE 811 3704 0100 000 FC 131545 099001 102577 5,000 00
Gracie Brinson 10/18/24
Yonne Cerna 10/18/2024
Vickie Koenig 11/12/2024
Samuel Graves
✔ 2
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.11.12 15:26:28 -05'00'
Yvonne Cerna Digitally signed by Yvonne Cerna Date: 2024.10.18 11:00:10 -04'00'
Gracie Brinson Digitally signed by Gracie Brinson Date: 2024.10.18 10:05:35 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.11.12 15:19:13 -05'00'
File details come from the government source that posted it. Updated .