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Print Permit Page 1 of 1 STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT TR-0120(REV.62000) Permit No. 10-11-6-SV-0427 In compliance with: olf2telPM 10-SJ-5 PM 28.53 El Your application of jare September 14, 2011 09/15/2011 11 Utility Paid eposit Utility Notice No. of 328 C1 Agreement No- of erforrnance Bond Amount(1) ayment Bond Amount(2) 0.00 0.00 EI and RNV Contract No. of Company ondNumber(1) ondNumber(2) TO: Palisades Gas&Wash c/o Stratus Environmental, Inc. 3330 Cameron Park Drive,Suite 550 Cameron Park,CA 95682 Attn: 530-676-2062 and subject to the following,PERMISSION IS HEREBY GRANTED to: PERMITTEE Abandon monitoring well, as shown on the location of the attached plans, within Interstate 5 right of way at Country Club Boulevard and Plymouth Road in the City of Stockton in San Joaquin County. This Permit also allows to conduct Traffic Control, place, maintain, and remove temporary warning signs. Upon the completion of groundwater monitoring, the well will be abandoned by pressure grouting with near cement to the ground surface. The well abandonment may be conducted at night to reduce the impact of traffic. All work shall be done in accordance to California Department of Transportation Standards and Specifications with an approval of the State Field Representative. A copy of this permit shall be placed in the vehicles involved in doing this work. Permittee shall notify the State Field Representative in the area before doing any work under this permit. A pre-job meeting with the assigned Department Representative, Joe Valdez, 948-3656, is required prior to start of any work under this permiti Failure to do so may result in permit revocation with no prejudice. THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANSFER WITH THE PROPERTY TO A NEW OWNER. The following attachments are also included as part of this permit(Check applicable): ®Yes ❑No General Provisions In addition to fee,the permittee will ❑Yes ®No Utility Maintenance Provisions be billed actual costs for: O Yes ❑No Storm Water Special Provisions ®Yes ❑No Special Provisions 0 Yes []No Review ❑Yes IN No A Cal-OSHA permit,if required:Permit No. ®Yes []No Inspection El Yes ®No As-Built Plans Submittal Route Slip for Locally Advertised Projects ®Yes 11 No Field Work ®Yes ❑No Storm Water Pollution Prevention Plan/Water Pollution Control Plan (if any Caltrans effort expended) ❑Yes ®No The information in the environmental documentation has been reviewed and considered prior to approval of this permit. This permit is void unless the work is completed before March_ 31, 2012 This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. No project work shall be commenced until all the other necessary permits and the environmental clearances have been obtained. PERMIT ENGINEER:Betty Tamae APPROVED: COPIES TO: Maintenance Carne Bowen,District Director BY: FM 91 1436(D10 Permit App.) NELSON MAGSAYO,P.E.,District Permit Engineer http://onramp/epennit/bin/print_permit.php?id=143293&disc=y 10/3/2011