CN-370000-LE811-3I-71841.pdf
PDF 160 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
Work Authorization Summary
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection, Office of Emergency Response. The document authorizes work to be performed by Cliff Berry Inc. under Contract LE811. The incident, identified as DEP Incident #2024-3I-71841, occurred on December 11, 2024, at NE 32nd Terrace & Andalusia Boulevard in Cape Coral, Lee County, Florida. The On-Scene Coordinator is Dave Glen, and the DEP Representative is David Glen.
The work authorization covers the removal and disposal of one abandoned 55-gallon drum containing used motor oil, which was inspected by Lee County Natural Resources with no release determined to be present. The work is classified as a fixed-price assignment with a total authorized amount of $1,300.00. The waste is profiled as Petroleum Non-hazardous. Cliff Berry Inc. will provide one supervisor and utilize a response truck for this task. The Level of Effort includes PPE Level D. Funding is sourced from Project LE 811, Organization Code 3704 0100 000, EO FL, Object Code 131545, Fund 099001, and Category/Year 102577. The form was executed with signatures from the DEP Representative, Contractor Representative, and OER Budget Representative on December 11-12, 2024, with final approval from Samuel Graves on December 16, 2024.
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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. 2024-3I-71841
LE811 Bill Reasoner 12/11/2024
NE 32nd Terrace & Andalusia Blvd Dave Glen
Ne 32nd Terrace & Andalusia Blvd. 239-633-5441
Cape Coral Lee 239-633-5441
Used oil in 55 gallon drum
D
Abandoned drum, used motor oil, checked by Lee County Natural Resources, no release present.
$1300.00
LE 811 3704 0100 000 FL 131545 099001 102577 1,300 00
Dave Glen 12/11/20214
12/12/2024
Vickie Koenig 12/12/2024
Samuel Graves
✔ Petroleum Non-haz.
✔ 1
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.12.12 14:04:04 -05'00'
William Reasoner Digitally signed by William Reasoner Date: 2024.12.12 08:55:49 -05'00'
David Glen Digitally signed by David Glen Date: 2024.12.11 14:17:02 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.12.16 11:23:31 -05'00'
File details come from the government source that posted it. Updated .