CN-370000-LE812-1I71997C.pdf
PDF 133 KB Posted
- Contract number
- LE812
- Issued by
- Florida
About this file
This document is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection's Office of Emergency Response for an environmental remediation project. The contractor is Perma-Fix, a company based in Jacksonville, with the specific work location being the Osceola National Forest in Columbia County, Florida. The incident involves the discovery and planned removal of six 55-gallon metal drums containing an unconfirmed substance identified as Terrarthane, a polyurethane injection product that will be manifested as hazardous waste.
The work authorization is for a fixed-price contract with a not-to-exceed amount of $7,000, funded through project LE 812 with specific organizational and object codes. The scope of work includes responding immediately, transporting drums to a treatment storage and disposal facility (TSDF), and conducting screening of two out of the six drums on January 17, 2025. The project will involve one supervisor and one recovery technician, utilizing a straight truck and requiring work clothes as personal protective equipment. Analytical and disposal arrangements will be handled via the contractor, with the drums being in fair condition and potentially requiring new bungs to secure their contents.
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Other files
| File | Type | Posted |
|---|---|---|
| ContractBudgetExport.csv | CSV file | |
| CN-370000-CN300-T1CO1.pdf | ||
| CN-370000-LE812-5I-69553.pdf | ||
| CN-370000-LE812.pdf | ||
| CN-370000-LE812-8C-70298.pdf | ||
| CN-370000-LE812-1I-69552.pdf |
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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
Perma-Fix 2025-1I-71997C
LE 812 January 17, 2025
Osceola National Forrest Drums Dumping Brierra T. Mack
NE. RANGE ROAD AT NE WILLIAMS ST, Lake City 904-256-1679
Jacksonville Columbia 904-673-5357
Terrarthane- a polyurethane injection product (Drum Label) Manifested as Hazardous Waste Liquid, NOS (UN3082; D001, D002)
Work Clothes
Removal and disposal of (6) 55-galon metal drums containing unconfirmed substances. Open 2 out of 6 drums for screening on 1/17/2025. Drums are in fair condition and should not require overpacking. A couple may need new bungs to secure contents. Exact Location: 30.197643685970352, -82.59607257510724
LE 812 3704 0100 000 FL 131545 099001 102577 7,000 00
Brierra Mack 2/10/2025
Vince Phillips 2/20/2025
Vickie Koenig 2/21/2025
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.02.21 13:24:03 -05'00'
Vince Phillips Digitally signed by Vince Phillips Date: 2025.02.20 13:07:45 -05'00'
Brierra Mack Digitally signed by Brierra Mack Date: 2025.02.10 15:06:00 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.02.24 08:53:49 -05'00'
File details come from the government source that posted it. Updated .