CN-370000-LE811-4C-69281.pdf
PDF 144 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's Office of Emergency Response. The document authorizes work under Contract LE811 between the state of Florida and Cliff Berry Inc. The work was authorized on July 26, 2022, for an incident (2022-4C-69281) at Apollo Beach, 954 Allegro Lane, Tampa, Hillsborough County. Key personnel involved include Jonathan Belcher (DEP Representative/OSC), Nicole Collins (Contractor Representative), Amanda Lanphere (OER Budget Representative), and Samuel Graves (Approving Official).
The authorized work involves the removal of an abandoned 55-gallon drum containing approximately 1/4 full of unknown material labeled as Phosphoric Acid from a neighborhood during normal business hours. The work assignment is structured as a fixed-price contract with an estimated not-to-exceed amount of $1,015. Analytical and disposal arrangements are handled via the contractor. Funding is provided from Project LE811, Organization Code 37040100000, with Object Code 139900, Fund Category 099001, and a total amount of $1,015 in Category/Year 102577. The work was approved by all required parties with digital signatures dated between July 26 and September 9, 2022.
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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 2022-4C-69281
LE811 7/26/22
Apollo Beach 954 Allegro Drum Jonathan Belcher
954 Allegro Lane 813-470-5908
Tampa Hillsborough 813-399-0581
55 Gallon Drum 1/4 full, unknown. Labeled Phosphoric Acid.
Cliff Berry was called to remove a potentially hazardous drum from a neighborhood during normal work hours.
LE811 37040100000 FL 139900 099001 102577 1015 00
Jonathan Belcher 7/26/22
Nicole Collins 8-8-22
Amanda Lanphere 8-9-22
Samuel Graves
✔ 1
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.09.09 09:30:25 -04'00'
Nicole Collins Digitally signed by Nicole Collins Date: 2022.08.09 08:45:15 -04'00'
Digitally signed by Jonathan Belcher Date: 2022.07.26 15:11:40 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.09.08 15:15:03 -04'00'
File details come from the government source that posted it. Updated .