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06401/2010 16:00 209-948-7-9 CALTRANS D10 PERMT 4 PAGE 01/04 <br /> STATE OF CALIFORNIA a DEPARTMENT OF TRANSPORTATION f �O6o"> <br /> ENCROACHMENT PERMIT G�� <br /> YR-0120(REV.2J9S) Permit No. <br /> 1010-65V-0245 <br /> WSbCb/Rte/PM <br /> In compliance with (Check one): <br /> 10SJ-4-R19.60 <br /> Your application of APRIL 27, 2010 <br /> Date <br /> ❑ Utility Notice No, Of JUNE 1, 2010 <br /> Fee Paid Deposit <br /> ❑ Agreement No. Of ` �` w ,,, $ $656 <br /> Performance Bond Amount(1) Payment Bond Amount(2) <br /> ❑ RAN Contract No. Of $ $ <br /> Bond Company <br /> Bond Number(1) Bond Nbmbef(2) <br /> TO: � <br /> THE SOURCE GROUP, INC. <br /> 944 MCCOURTNEY ROAD,SUITE H <br /> GRASS VALLEY,CA 96949 <br /> ATTN: ADAM BROWN <br /> TEL :(530)272-4200 <br /> PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Abandon wells and remove four vaults, as shown on the attachments, within State Highway 4 <br /> right of way at Filbert Street on-ramp in the City Stockton in San Joaquin County. Upon the <br /> completion of groundwater monitoring, the well will be abandoned by pressure grouting with <br /> near cement to the ground surface. The work may be conducted at night to reduce the impact of <br /> traffic. This Permit also allows to conduct Traffic Control and placement of temporary <br /> construction warning signs. All work shall be done in accordance to the California Department <br /> of Transportation Standards and Specification with an approval of the State Field Representative. <br /> A copy of this permit shall be placed in the vehicles involved in doing this work. Permittee shall <br /> notify the State Field Representative in the area before doing any work under this permit. <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 /> (If any Caltrans effort expended) <br /> ❑ Yes ® 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 31,2010. <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. <br /> N r work shall be commenced until all other neoessa ern its and environmental clearances have been obtained. <br /> ORIGINAL•PerniNee PPlxoveD: <br /> 1 -File <br /> 2-JOSEPH A.VALDEZ <br /> I-MAINTENANCE ROSS CHITTENDEN, District Director / <br /> I-ZELTENOGUEMA a e -FIV <br /> F zod o <br /> e N <br /> Betty TemaELSON MAGSAYO District Permit En ineer // <br /> FM 91 1436 <br />