CN-370000-LE811-3I-69767.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 emergency response services under contract LE811 with contractor CBI for incident number 2023-3I-69767. The incident occurred on January 12, 2023, at 2613 Gretchen Avenue South in Lehigh Acres, Lee County, Florida, under the supervision of On-Scene Coordinator (OSC) Johnny Seay.
The work authorization specifies the removal and handling of two 55-gallon drums with no bulges or leaking located on the east side of Gretchen Avenue South. The scope includes abandoned drum response classified as a fixed-price work assignment. The level of effort includes two recovery technicians and one pickup or van vehicle. The funding allocation is $4,500.00, charged to Project No. LE 811, Organization Code 37040100000, Object Code 131545, Fund Category 099001 (Category/Year 12577). The authorization was executed with signatures from DEP Representative Johnny Seay (January 12, 2023), Contractor Representative Steve Swett (January 12, 2023), and OER Budget Representative Amanda Lanphere (January 13, 2023), with final approval by Samuel Graves.
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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-69767
LE811 1/12/2023
UNKNOWN SEAY
2613 GRETCHEN AVENUE S 2396335441
LEHIGH ACRES LEE 2396335441
(2) 55GAL DRUMS, NO BULGES AND NO LEAKING. ON EAST SIDE OF GRETCHEN AVENYE S
LE 811 37040100000 FC 131545 099001 12577 4500 00
JOHNNY SEAY 1/12/2023
Steve Swett 1-12-23
Amanda Lanphere 1/13/2023
Samuel Graves
✔ 2X
✔ 2X
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.01.13 13:47:45 -05'00'
Steve Swett Digitally signed by Steve Swett Date: 2023.01.12 15:12:08 -05'00'
Johnny Seay Digitally signed by Johnny Seay Date: 2023.01.12 14:50:41 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2023.01.12 15:42:34 -05'00'
File details come from the government source that posted it. Updated .