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STATE OF CALIFORNIA-DEPARTMENTAmdRANSPORTATiON 5 K b5 Z0140 <br /> ENCROACHMENT PERMIT <br /> 00 <br /> TR-0120(REV.2/98) 1No. <br /> 007-6SV-0661 <br /> D'Ist/ColRtWPM <br /> In compliance with (Check one): <br /> 10-SJ-5-28.53 <br /> Your application of AUGUST 23,2007 <br /> Date <br /> ❑ Utility Notice No. of AUGUST 27, 2007 <br /> Fee Paid Deposit <br /> ❑ Agreement No. Of $ $328 <br /> Performance Bond Amount(1) Payment Bond Amount <br /> ❑ <br /> RNV Contract No. of $ 5000 $0 <br /> Bond Company <br /> RLI INSURANCE COMPANY <br /> Bond Number(1) Bond Number(2) <br /> TO: CMS231101 NA <br /> PALSADES GAS &WASH. INC. <br /> 3301 CAMERON PARK DRIVE, SUITE 550 <br /> CAMERON PARK, CA 95682 2� <br /> ATTN: SCOTT SITTINGER <br /> I <br /> TEL : (530) 676-2062 <br /> PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Install two monitoring wells, maintain, and sample wells within Interstate 5 right of way off <br /> ramp at Plymouth Road and Country Club Boulevard intersection in the City of Stockton in San <br /> Joaquin County as shown on the attachment. Upon the completion of groundwater monitoring, <br /> the wellith near cement to the ground surface. The <br /> well drillin ms a conucte night to reduce the impact of traffic. A copy <br /> of this permit shall be placed in the vehicles involved in doing this work. Permittee shall notify <br /> the State representative in the area before doing any work under this permit. This permit shall <br /> be renewed before expiration date. <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 ® 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 /> # (!f 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 DECEMBER 31, 2009. <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. <br /> No PrOW work shall be commenced until all other necessa errttits and environmental clearances have been obtained. <br /> 1-Permittee APPR7VEDi <br /> 1-File <br /> 2—Joseph A.Valdez <br /> K0,%4E;Q i"'E, District Director <br /> �''" �/2-7kcBetty Tamae NELS MAG ermit En ineer <br /> FM 91 14M <br />