CN-370000-LE811-4I-73046.pdf
PDF 160 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, authorizing Cliff Berry Inc (CBI) to perform emergency response work. The document is dated August 8, 2025, and corresponds to DEP Incident #2025-4I-73046 at a site located at 24th Avenue South and South 58th Street in Tampa, Hillsborough County, Florida. Jon Belcher serves as the On-Scene Coordinator, with Aiden Tellier as the contractor representative.
The work authorization is for the removal and transport of approximately 10 gallons of used oil contained in an IBC (Intermediate Bulk Container) tote designated as an abandoned drum. The level of effort includes one recovery technician, one straight truck, and one 55-gallon drum, with personnel wearing work clothes as personal protective equipment. The work is classified as a fixed-price authorization with a not-to-exceed amount of $1,500. Funding is allocated from Project LE 811 under organization code 3704 0100 000, with object code 131545, fund category 099001, and the full amount of $1,500 is charged to category/year 102577. All required signatures were executed digitally on August 8, 2025, by the DEP representative (Jon Belcher), contractor representative (Aiden Tellier), and OER Budget Representative (Vickie Koenig).
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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-73046
LE811 Aiden Tellier 8/8/2025
24th Ave S Tote Jon Belcher
24th Ave S and S 58th 813-470-5908
Tampa Hillsborough 813-399-0581 approximately 10 gallons of used oil in an IBC tote work clothes
Appears transportable.
1,500
LE 811 3704 0100 000 FL 131545 099001 102577 1,500 00
Jon Belcher aiden tellier
Vickie Koenig 8/8/2025
Samuel Graves
(1) IBC tote
✔ 1
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.08.08 14:47:28 -04'00'
Aiden Tellier Digitally signed by Aiden Tellier Date: 2025.08.08 14:34:20 -04'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2025.08.08 11:17:06 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.08.08 14:39:56 -04'00'
File details come from the government source that posted it. Updated .