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Print Permit Page 1 of 1 STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT Permit No TR-0120(REV.602000) 10-11-6-SV-0427 In compliance with: isf/CoIRte/PM 10-SJ-5 PM 28.53 ®Your application of ate September 14, 2011 09/15/2011 fncdl Paid ❑Utility Notice No. of 326 13 Agreement NO. of ortnance Bond Amount(1) ayment Bond Amount(2) .o0 0.00 ❑R/W Contrail No. of Ntxriber'(1) ndNum r(2) To: Palisades Gas$Wash c/o Stratus Environmental, Inc. 3330 Cameron Park Drive,Suite 550 Cameron Park,CA 95682 Attn: 530-676-2062 ,PERMITTEE and subject to the following,PERMISSION IS HEREBY GRANTED to: 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 pro-job meeting with the assigned Department Representative, Joe Valdez, 948-3656, is required prior to start of any work under this permit! 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): O Yes ❑No General Provisions In addition to fee,the permittee will ❑Yes ®No Utility Maintenance Provisions be billed actual costs for. M Yes ❑No Storm Water Special Provisions ®Yes ❑No Review ®Yes ❑No Special Provisions ❑Yes ®No A Cal-OSHA permit,if required:Permit No. ®Yes ❑No Inspection ❑Yes ®No As-Built Pians Submittal Route Slip for Locally Advertised Projects ®Yes ❑No Field Work ®Yes ❑No Storm Water Pollution Prevention Plan/Water Pollution Control Plan (if any Callrans 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 Tames APPROVED: COPI ES TO: Maintenance Carrie Bowen,District Director BY: NELSON MAGSAYO,P.E.,District Permit Engineer FM 91 1436(D10 Permit App.) http://onramp/eperrnit/bin/print_pennit.php?id=143293&disc=y 10/3/2011