CN-370000-LE811-4I-69889.pdf
PDF 130 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 (DEP), Office of Emergency Response (OER), authorizing work to be performed by Cliff Berry Inc (CBI) under Contract #LE811. The incident number is 2023-4I-69889, dated March 21, 2023, at the Proxitane Dump site located at End of Street of S Grady Ave in Tampa, Hillsborough County, Florida. The incident was managed by On-Scene Coordinator Jonathan Belcher, with DEP Representative Sean Lynch and Contractor Representative Jon Sandora executing the authorization on March 21, 2023, followed by OER Budget Representative Amanda Lanphere on March 23, 2023.
The work involves response to an abandoned drum incident containing approximately 165 gallons of Proxitane stored in three 55-gallon drums. The scope of work includes emergency response and abandoned drum handling. Analytical and disposal arrangements are being managed via the contractor. The work assignment is structured as a fixed-price authorization with a not-to-exceed estimate amount of $5,500. The project is charged to Project No. LE811, Organization Code 37040100000, with Object Code 131545 and Fund Category/Year 102577. The total authorized amount is $5,500, funded through the designated project structure.
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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) 2023-4I-69889
LE811 Jon Sandora 3/21/2023
Proxitane Dump Jonathan Belcher
End of Street of S Grady Ave (27.8957690, -82.5102683) 813-470-5908
Tampa Hillsborough 813-399-0581
~165 gallons of Proxitane in three 55-gallon drums.
5,500
LE811 37040100000 FC 131545 099001 102577 5500 00
Sean Lynch 3/21/2023
Jon Sandora 3/21/2023
Amanda Lanphere 3/23/2023
Samuel Graves
✔ 3
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.03.23 14:37:15 -04'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2023.03.21 14:58:34 -04'00'
Sean Lynch Digitally signed by Sean Lynch Date: 2023.03.21 14:11:17 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2023.03.23 14:44:43 -04'00'
File details come from the government source that posted it. Updated .