CN-370000-LE811-3I-69761.pdf
PDF 130 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
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 (OER). The document authorizes work under contract LE811 with Cliff Berry Inc. (CBI) for incident 2023-3I-69761 occurring on January 6, 2023, at Church Road in Lehigh Acres, Lee County, Florida. The form was signed by DEP Representative Johnny Seay, Contractor Representative Bill Scott, and OER Budget Representative Amanda Lanphere.
The work authorization covers the response to an abandoned drum containing approximately 20-25 gallons of kerosene. The scope of work includes response and recovery operations utilizing a response truck, 55-gallon drums, vapor detector, and PPE Level B equipment. The work is assigned on a fixed-price basis with a not-to-exceed estimate of $3,500. Funding is provided through Project LE811, Organization Code 37040100000, with Object Code 131545, Fund Category/Year 12577, and a total amount of $3,500.00. The form indicates that analytical and disposal arrangements will be determined per the contractor's scope of work, with the contract manager responsible for reviewing and evaluating all deliverables to ensure complete and timely documentation.
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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
CBI 2023-3I-69761
LE811 1/6/2023
UNKNOWN YANC/SEAY
CHURCH RD LEHIGH ACRES
LEHIGH ACRES LEE 2396335441
APPROXIMATELY 20-25GAL OF KEROSENE
B
LE811 37040100000 FC 131545 099001 12577 3500 00
Johnny Seay 1/6/2023
Cliff Berry Inc. 1/6/23
Amanda Lanphere 1/13/2023
Samuel Graves
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.01.13 13:53:34 -05'00'
Bill Scott Digitally signed by Bill Scott Date: 2023.01.06 14:58:43 -05'00'
Johnny Seay Digitally signed by Johnny Seay Date: 2023.01.06 14:12:27 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2023.01.09 09:05:08 -05'00'
File details come from the government source that posted it. Updated .