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*saw v <br /> STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.2/98) <br /> Permit No. <br /> 1014 6MW 0221 <br /> Dist/Co/RtelPM <br /> In compliance with (Check one): <br /> Your application of APRIL 10,2014 10-SJ-4-16.64 <br /> Date <br /> ❑ Utility Notice No. Of APRIL 11, 2014 <br /> Fee Paid Deposit <br /> El of No. Of $ <br /> $ 164 <br /> Fl RAN Contract No. Of <br /> Performance Bond Amount(1) Payment Bond Amount(2) <br /> $ <br /> Bond Company <br /> TO: Bond Number(1) Bond Number(2) <br /> CHEVRON ENVIRONMENTAL MANAGEMENT CO. <br /> 6101 BOLLINGER CANYON ROAD <br /> SAN RAMON, CA 94583 <br /> ATTN: TODD MCFARLAND <br /> TEL : (909)579-3975 <br /> I 1 <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: PERMITTEE <br /> Abandon four (4) monitoring wells to a maximum depth of 60 feet below grade, as shown on the <br /> attachment, within State Highway 4 right of way at East Washington Street in San Joaquin <br /> County. This Permit also allows to conduct traffic control if necessary, place, maintain, and <br /> remove temporary warning signs during the abandonment of the monitoring well. This Permit <br /> does not allow lane closures on the State Highway 4 mainline. Upon the completion of work, <br /> the borings shall be abandoned in accordance to California Department of Transportation <br /> Standards and Specifications with an approval of the State Field Representative. A copy of this <br /> permit shall be placed in the vehicles involved in doing this work. Permittee shall notify the <br /> State Field Representative in the area before doing any work under this permit. <br /> The following attachments are also included as part of this permit In addition to fee,the permittee will be billed <br /> (Check applicable): actual costs for: <br /> ® Yes ❑ No General Provisions <br /> ® Yes ❑ No Review <br /> ❑ Yes ® No Utility Maintenance Provisions ® Yes ❑ No Inspection <br /> ® Yes ❑ No Special Provisions T,TR-400 ® Yes ❑ No Field Work <br /> ❑ Yes ® No A Cal-OSHA permit required prior to beginning work: <br /> # (If any Caltrans effort expended) <br /> ❑ Yes ® NO The information in the environmental documentation has been reviewed and is considered prior to approval of this <br /> permit. <br /> This permit expires on or before: DECEMBER 31, 2014. <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. <br /> No project work shall be commenced until all other necessary pe its and environmental clearances have been obtained. <br /> ORIGINAL-Permittee APPROVED: <br /> 1 -File <br /> 2—JOSEPH A.VALDEZ <br /> 1-MAINTENANCE AMARJEET BENIPAL. Acting, District Director <br /> 1-PIO BY:�--- <br /> Betty Tamae NELSON MAGSAYO, District Permit Engineer <br /> FM 91 1436 <br />