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Print Permit Page 1 of 1 <br /> STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT PeffnIt No. <br /> TR-0120(REV.8000) 10-11-6-SV-0427 <br /> In compliance with: 10-SJ-5 PM 28.53 <br /> ®Your application of <br /> Sept ember 14 2011 09/15/2011 <br /> ee Paid <br /> 17 utility Notice No. of F;, <br /> ance Bond Amount(1) Bond Amount(2) <br /> 0 Agreernent No. of 0.00 <br /> Company <br /> O RNV Contract No. of <br /> Number(1) Number(2) <br /> TO: Palisades Gas&Wash <br /> do Stratus Environmental,Inc. <br /> 3330 Cameron Park Drive,Suite 550 <br /> Cameron Park,CA 95682 <br /> Attn: 530-676-2062 ,PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Abandon monitoring well, as shown on the location of the attached plans, within Interstate <br /> 5 right of way at Country Club Boulevard and Plymouth Road in the City of Stockton in San <br /> Joaquin County. This Permit also allows to conduct Traffic Control, place, maintain, and <br /> remove temporary warning signs. Upon the completion of groundwater monitoring, the well <br /> will be abandoned by pressure grouting with near cement to the ground surface. The well <br /> abandonment may be conducted at night to reduce the impact of traffic. All work shall be <br /> done in accordance to California Department of Transportation Standards and Specifications <br /> with an approval of the State Field Representative. A copy of this permit shall be placed <br /> in the vehicles involved in doing this work. Permittee shall notify the State Field <br /> Representative in the area before doing any work under this permit. <br /> A pre-job meeting with the assigned Department Representative, Joe Valdez, 948-3656, is required prior <br /> to start of any work under this permit[ Failure to do so may result in permit revocation with no <br /> prejudia <br /> THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANSFER WITH THE PROPERTY TO A NEW OWNER. <br /> The attadtments are also included as part of this permit(Check applicable): <br /> Byes O No General Provisions In addition to fee,the permittee will <br /> O Yes ®No Utility Maintenance Provisions be billed actual costs for: <br /> M Yes O No Storm Water Special Provisions <br /> ®Yes I3 No Review <br /> ®Yes O No Special Provisions <br /> Yes O No Inspection <br /> O Yes ®No A Cal-OSHA permit,N required:Permit No. M <br /> ®Yes O No Field Work <br /> O Yss M No As-Built Plans Submittal Route Slip for Locally Advertised Projects <br /> ®Yes O No Storm Water Pollution Prevention Pian/Water Pollution Control Plan (if any Callrans effort expended) <br /> O Yes ®No The information in the environmental documentation has been reviewed and considered prior to <br /> approval of this permit. <br /> This permit is void unless the work is completed before ?% oh 31, 2012-T_ <br /> This permit is to be sWkdy construed and no other work other than specifically mentioned is hereby authorized. <br /> No project work shall be commenced until all the other necessary permits and the environmental clearances have been obtained. <br /> PERW :Betty TemseAPPROVED: <br /> COPIES To: <br /> Maintriance <br /> Carrie Bowen,District Director <br /> BY: <br /> NELSON MAGSAYO,P.E..District Penna Enginew <br /> FM 911436( 10 PerniftApp.) <br /> http://onramp/epermit/bin/print_permit.php?id=143293&disc=y 10/3/2011 <br />