CN-370000-LE811-4I-72490.pdf
PDF 159 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 (FDEP), Office of Emergency Response (OER), authorizing work under contract LE811 with Cliff Berry Inc. (CBI). The document pertains to incident 2025-4I-72490 dated March 28, 2025, located in Sun City Center, Hillsborough County. The on-scene coordinator (OSC) is Jon Belcher, and the contractor representative is Aiden Tellier. The work site coordinates are 27.7428734, -82.3222749.
The authorization covers the recovery and transport of one 55-gallon steel drum containing used motor oil and miscellaneous petroleum from the incident site. The contractor has been designated as responsible for the complete removal and disposal arrangement via the contractor. The work assignment is structured as a fixed-price contract with a not-to-exceed amount of $1,400. The contractor will provide one recovery technician and one straight truck for the operation. Funding is allocated from Project LE 811, Organization Code 3704 0100 000, with an object code of 131545 and fund category 099001 (102577), with a total authorized amount of $1,400.00. The authorization was executed by contractor representative Aiden Tellier on March 28, 2025, and approved by FDEP Representative Jon Belcher and OER Budget Representative Vickie Koenig on March 31, 2025.
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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) 2025-4I-72490
LE811 Aiden Tellier 3/28/25
Bill Tucker/West Lake Jon Belcher
27.7428734, -82.3222749 813-470-5908
Sun City Center Hillsborough 813-399-0581
(1) 55 gal steel drum, full of used motor oil/misc petroleum.
Drum appears transportable, no major damage observed.
1,400
LE 811 3704 0100 000 FL 131545 099001 102577 1,400 00
Jon Belcher
AIDEN TELLIER 3/28/2025
Vickie Koenig 3/31/2025
Samuel Graves
✔ 1
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.03.31 13:29:17 -04'00'
Aiden Tellier Digitally signed by Aiden Tellier Date: 2025.03.28 11:00:57 -04'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2025.03.28 10:14:06 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.03.31 15:48:27 -04'00'
File details come from the government source that posted it. Updated .