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STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.219$) Permit No. <br /> 1011-6SV-0427 <br /> Dist/Co/Rte/PM <br /> In compliance with(Check one): <br /> Your application of 10-SJ-5-28.53 <br /> SEPTEMBER 14,2011 <br /> Date <br /> ❑ Utility Notice No. Of SEPTEMBER 15, 2011 <br /> Fee Paid Deposit <br /> ❑ Agreement No. Of $ $ 328 <br /> Performance Bond Amount(1) Payment Bond Amount(2; <br /> ❑ RNV Contract No. Of $ a <br /> Bond Company <br /> Bond Number(1) gond Number(2) <br /> TO:' <br /> PALISADES GAS&WASH <br /> C/O STRATUS ENVIRONMENTAL,INC. <br /> 3330 CAMERON PARK DRIVE,SUITE 550 <br /> CAMERON PARk,CA 95682 <br /> ATTN: SCOTT BITTINGER <br /> TEL : (530)676-2062 <br /> 1 i <br /> PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Abandon monitoring well, as shown on the location of the attached pians, within Interstate 5 <br /> 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 will <br /> 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 done <br /> in accordance to California Department of Transportation Standards and Specifications with an <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 E] No General Provisions <br /> ® Yes ❑ No Review <br /> ❑ Yes ® No Utility Maintenance Provisions ® Yes ❑ No Inspection <br /> ® Yes ❑ No Special Provisions T ® Yes ❑ No Field Work <br /> ❑ Yes ® No A Cal-OSHA permit required prior to beginning work; <br /> # (If any Caltrans effort expended) <br /> Yes Z No The information in the environmental documentation has been reviewed and is considered prior to approval of this <br /> permit. <br /> This permit is void unless the work is complete on or before MARCH 31,2012. <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authored. <br /> No project work shall be commenced until all other necessary its and environmental clearances have been obtained. <br /> ORIGINAL-Permittee APPROVED: <br /> 1-Ffle <br /> 2—JOSEPH A.VALDEZ <br /> 1-MAINTENANCE CARRIE BOWEN District Director <br /> 1-ZELIE NOGUEIRA BY: <br /> i <br /> Betty Tames rN A O ,District a it En inter <br /> FM 91 1436 _........... <br />