CN-370000-LE811-4C-71668.pdf
PDF 123 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), to authorize emergency response services. The involved parties include FDEP as the authorizing agency, Cliff Berry Inc (CBI) as the contractor, and personnel including DEP Representative Jon Belcher, Contractor Representative Aiden Tellier, and OER Budget Representative Vickie Koenig. The authorization is associated with DEP Incident #2024-4C-71668 (FD096) dated October 25, 2024, located at Ulmerton Drum in Saint Petersburg, Pinellas County, Florida.
The work authorization covers the handling of one 55-gallon drum containing approximately 5% Mineral Spirits (solvent) labeled "Pave Cure." The primary services include overpack drums and abandoned drum response (1 unit). The level of effort includes one supervisor, one recovery technician, one straight truck, and one overpack drum with associated equipment. The work assignment is structured as a fixed price contract with a not-to-exceed estimate amount of $2,000.00. Funding is provided through Project LE 811 under Organization Code 3704 0100 000, Object Code 131545, Fund 099001, Category/Year 102577, with the approved amount of $2,000.00. The authorization was executed and digitally signed on October 28, 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 (CBI) 2024-4C-71668 (FD096)
LE811 Aiden Tellier 10/25/2024
Ulmerton Drum Jon Belcher
27.8942100, -82.6508211 813-470-5908
Saint Petersburg Pinellas 813-399-0581
(1) 55 gal drum of "Pave Cure" - approximately 5% Mineral Spirits (solvent). Drum does not appear transportable.
Drum is full, and does not appear transportable. Will either need to be overpacked, or transfer to new drum.
LE 811 3704 0100 000 FC 131545 099001 102577 2,000 00
Jon Belcher
Aiden Tellier
Vickie Koenig 10/28/2024
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.10.28 09:46:39 -04'00'
Aiden Tellier Digitally signed by Aiden Tellier Date: 2024.10.28 08:03:31 -04'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2024.10.28 08:25:24 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.10.28 09:23:43 -04'00'
File details come from the government source that posted it. Updated .