CN-370000-LE811-1I-73225.pdf
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- Contract number
- LE811
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (OER_13, Effective 7-01-2017) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response. The document authorizes work under Contract LE811 with contractor Cliff Berry for incident 2025-11-73225 at 5134 Highway Avenue in Jacksonville, Duval County, Florida. The form was executed on October 22, 2025, with incident response required to begin immediately on October 23, 2025 at 0800 hours. The On-Scene Coordinator is Ryan Keane.
The authorized work involves the transport of drums to a Treatment Storage and Disposal Facility (TSDF) for one 55-gallon poly drum containing 90 percent full mineral oil. The work assignment is fixed price with a not-to-exceed estimate amount of $1,270. Analytical and disposal arrangements are handled via the contractor. Funding is approved from Project LE811, Organization Code 3704 0100 000, with Object Code 131545, Fund 099001, Category/Year 102577, in the amount of $1,270. The form is signed by DEP Representative Ryan Keane (10/22/2025), Contractor Representative Yvonne Cerna (10/23/2025), and OER Budget Representative Vickie Koenig (11/17/2025).
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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
Cliff Berry 2025-1I-73225
LE811 10/22/2025
5134 Highway Ave. Ryan Keane
5134 Highway Ave. 904-917-0000
Jacksonville Duval 904-917-0000
10/23/2025 0800
One 55 gallon poly drum containing 90% full mineral oil.
1,270
LE811 3704 0100 000 FL 131545 099001 102577 1,270 00
Ryan Keane 10/22/2025
Yvonne Cerna 10/23/2025
Vickie Koenig 11/17/2025
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.11.17 13:09:57 -05'00'
Yvonne Cerna Digitally signed by Yvonne Cerna Date: 2025.10.23 07:26:11 -04'00'
Ryan Keane Digitally signed by Ryan Keane Date: 2025.10.22 13:57:03 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.11.17 13:07:13 -05'00'
File details come from the government source that posted it. Updated .