CN-370000-LE811-3C-69541.pdf
PDF 131 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection, Office of Emergency Response, in connection with emergency response services provided by Cliff Berry, Inc. under Contract LE811. The authorization pertains to DEP Incident #FD091-2022-3C-69541Z, dated September 28, 2022, related to Hurricane Ian recovery operations at Pine Island in Lee County, Florida. The incident was reported by On-Scene Coordinator Gracie Kennedy and involves the response to an abandoned drum of acid discovered during fire department reconnaissance.
The work scope includes immediate response to secure and transport a 15 to 20-gallon drum of acid (pH 1) and a 55-gallon drum of 5-6pH aqueous liquid for proper disposal, with potential overpacking requirements. The work is authorized on a fixed-price basis with a not-to-exceed amount of $2,500. The hazardous wastes are profiled as HW corrosive (D002) and non-hazardous aqueous liquid, with analytical and disposal services to be arranged via the contractor. Funding is allocated from Project LE811, Organization Code 37040100000, Object Code 139900, Fund Category 102577, with all required approvals obtained from the DEP Representative, Contractor Representative, and OER Budget Representative on October 11, 2022.
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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. FD091 - 2022-3C-69541Z
LE811 Bill Reasoner 09/28/2022 - Ian related
Pine Island - acid drum Gracie Kennedy
2651 Bridgeview St. 904-256-1528
Matlacha Lee 904-237-6261
10/09/2022
15 to 20-gallon drum of acid (pH 1) / 55-gallon drum 5 - 6pH aqueous liquid mob + disposal
Hurricane Ian related abandoned drum of acid found by Fire HazMat Team doing recon needs to be secured and transported for proper disposal. May require overpack.
Coordinate with OSC for pick up time and profile.
2,500
LE811 37040100000 FC 139900 099001 102577 $2500 00
Melissa Woehle 10/11/2022
William Reasoner 10/11/2022
Amanda Lanphere 10/11/2022
Samuel Graves
HW corrosive (D002) / non-haz aqueous liquid
✔ 2
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.10.11 15:35:54 -04'00'
William Reasoner Digitally signed by William Reasoner Date: 2022.10.11 14:29:16 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2022.10.11 11:15:00 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.10.11 14:52:41 -04'00'
File details come from the government source that posted it. Updated .