CN-370000-LE811-4I71536C.pdf
PDF 457 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 emergency response work by Cliff Berry Inc (CBI) under Contract LE811, with representative Jon Sandora. The work is associated with DEP Incident 2024-4I-71536C, dated September 13, 2024, located in Saffold Road, Wimauma, Hillsborough County, Florida. The On-Scene Coordinator is Jon Belcher, and the work involves response to an abandoned drum containing approximately 1.55 gallons of used oil impacted debris.
The authorized work includes one supervisor and one recovery technician utilizing a response truck, with PPE Level D required. The response team will handle the abandoned drum, with analytical and disposal arrangements managed via the contractor. The work is assigned as fixed price with a not-to-exceed estimate of $1,700. Funding is provided through Project LE 811, Organization Code 3704 0100 000, Object Code 131545, Fund 099001, Category/Year 102577, Amount $1,700.00. The form is approved and signed by DEP Representative Jon Belcher, Contractor Representative Jon Sandora, and OER Budget Representative Vickie Koenig, dated September 16, 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
File details come from the government source that posted it. Updated .