CN-370000-LE811-3I-69856.pdf
PDF 138 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 (FDEP), Office of Emergency Response. The document authorizes work under Contract LE811 with CBI, a contractor engaged for emergency response services. The incident, identified as 2023-3I-69856, occurred on March 3, 2023, at the Cape Coral Poly drum Site in Cape Coral, Lee County, Florida. The On-Scene Coordinator is John Yanc, with authorized representatives from both FDEP and the contractor signing the document to approve the work assignment.
The work authorization covers an abandoned drum response requiring recovery technician personnel and a pickup or van vehicle to address two poly drums containing suspected kerosene and petroleum products. The work is designated as a fixed price assignment with a not-to-exceed estimate of $2,500.00. The overpack drums equipment and associated response activities are authorized under this single work authorization. Funding is allocated from Project LE811, Organization Code 37040100000, with an Object Code of 131545, Fund Category/Year 102577, and the full $2,500.00 amount sourced from Fund 099001. All required approvals were digitally signed on March 3, 2023, by the DEP Representative, Contractor Representative, and OER Budget Representative.
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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-69856
LE811 Kelly Brandenburg 3/3/2023
Cape Coral Poly drum Site John Yanc
Lat: 26.699831, Long: -81.996792
Cape Coral Lee 239-771-0500
2 Poly drums with suspected Keroseen and petroleum products
2500.00
LE811 37040100000 FC 131545 099001 102577 2500 00
John Yanc 3/3/2023
Steve Swett 3-03-23
Amanda Lanphere 3/3/2023
Samuel Graves
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.03.03 14:01:04 -05'00'
Steve Swett Digitally signed by Steve Swett Date: 2023.03.03 11:51:35 -05'00'
John Yanc Digitally signed by John Yanc Date: 2023.03.03 12:00:12 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2023.03.03 13:06:31 -05'00'
File details come from the government source that posted it. Updated .