CN-370000-LE811-3I71733Z.pdf
PDF 122 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's Office of Emergency Response. The document authorizes work to be performed by Cliff Berry Inc under Contract LE811 at the intersection of Laurel Drive and North Tamiami Trail in North Fort Myers, Lee County, Florida. The incident number is 2024-3I-71733Z, dated October 30, 2024, with Sam Walch serving as the On-Scene Coordinator. The work authorization was approved by Samuel Graves (DEP), Sam Walch (DEP Representative), William Reasoner (Contractor Representative), and Vickie Koenig (OER Budget Representative).
The work scope includes soil removal and transport of drums to a Treatment Storage and Disposal Facility (TSDF), with one abandoned drum authorization and an extra drum for soil pre-approved. The suspected material is non-hazardous petroleum. The level of effort includes one equipment operator, one response truck, two 55-gallon drums, and PPE Level D. The work assignment is structured as a fixed-price contract with a not-to-exceed amount of $1,500. Funding is allocated from Project LE 811, Organization Code 3704 0100 000, with Fund Category/Year 102577, charged to Object Code 131545 and Fund 099001.
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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-71733Z
LE811 10/30/2024
Laurel Dr & N Tamiami Trl intersection Sam Walch
Laurel Dr & 41 intersection (239) 344-5639
North Fort Myers Lee (239) 810-9505
Extra drum for soil is pre approved.
1 D
LE 811 3704 0100 000 FC 131545 099001 102577 1,500 00
Sam Walch 10/30/2024
William Reasoner 10/30/2024
Vickie Koenig 10/30/2024
Samuel Graves
Non Hazardous petroleum
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.10.30 16:18:14 -04'00'
William Reasoner Digitally signed by William Reasoner Date: 2024.10.30 15:34:14 -04'00'
Sam Walch Digitally signed by Sam Walch Date: 2024.10.30 15:38:49 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.10.31 16:02:51 -04'00'
File details come from the government source that posted it. Updated .