CN-370000-LE811-4C71668S.pdf
PDF 489 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection (DEP), Office of Emergency Response (OER). The form authorizes work under Contract #LE811 between DEP and Cliff Berry Inc. (CBI). The incident involves an abandoned drum containing approximately 55 gallons of "Pave Cure" (approximately 5% mineral spirits solvent) located in Saint Petersburg, Pinellas County, Florida. The incident was documented on October 25, 2024, under DEP Incident #2024-4C71668, with Jon Belcher serving as the On-Scene Coordinator.
The authorized work includes overpack drums and management of one abandoned drum, utilizing one supervisor and one recovery technician, along with one straight truck and one overpack drum. The work is assigned as fixed price with a not-to-exceed estimate amount of $137. Funding is allocated from Project No. LE811, Organization Code 3704 0100 000, with Object Code 131545, Fund 099001, and Category/Year 102577. The form was approved and executed by Samuel Graves (DEP Representative), Aiden Tellier (Contractor Representative), and Vickie Koenig (OER Budget Representative) on May 7, 2025. The work requires immediate response coordination with the OSC to establish the specific date and time for execution.
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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
File details come from the government source that posted it. Updated .