CN-370000-LE811-7I-71417.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's Office of Emergency Response. The document authorizes work performed by Cliff Berry Inc. under Contract LE811. The incident, numbered 2024-7I-71417, occurred on August 2, 2024, at Junction Road in Zellwood, Orange County, Florida, approximately 100 yards north of SR-441. The on-scene coordinator is Travis Burch, with Christopher L. Blanton serving as the contractor representative. The form was executed with digital signatures from all required parties between August 3 and September 18, 2024.
The work authorization specifies mobile and disposal services for the removal and disposition of abandoned drums containing 75 gallons of non-hazardous used engine oil. The scope includes mobilization and disposal of two 55-gallon drums at a fixed price of $1,240.00. Funding is allocated from Project LE 811, Organization Code 3704 0100 000, with an Object Code of 131545 under Fund Category 099001 (102577). The contract rate structure classifies this as a "Mobe and Disposal" service. All required approvals were obtained from the DEP Representative, Contractor Representative, and OER Budget Representative prior to work authorization.
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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. 2024-7I-71417
LE811 Chris Blanton 8/2/2024
Junction Road Abandoned Drums Travis Burch
Junction Rd, 100 yards north of SR-441 407-897-4335
Zellwood Orange 321-388-6371
8/3/2024
75 gallons, non-haz used engine oil
Mobe and Disposal
LE 811 3704 0100 000 FC 131545 099001 102577 1,240 00
Travis Burch 8/3/2024
Christopher L. Blanton 09.12.2024
Vickie Koenig 9/12/2024
Samuel Graves
✔ 2 - 55 gal
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.09.12 10:16:37 -04'00'
Christopher L. Blanton Digitally signed by Christopher L. Blanton Date: 2024.09.12 09:17:14 -04'00'
Travis Burch Digitally signed by Travis Burch Date: 2024.08.09 08:32:21 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.09.18 08:45:13 -04'00'
File details come from the government source that posted it. Updated .