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STATE OF CALIFORNIA.DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.6/2012) Permit No. <br /> 1019-6SV-0674 <br /> Dist/Co/Rte/PM <br /> In compliance with(Check one): <br /> 10-SJ-4-17.002/17.068 <br /> ® Your application of September 25, 2019 <br /> Date <br /> Utility Notice No. of October 22, 2019 <br /> Fee Paid Deposit <br /> Agreement No. of $ $ 656.00 <br /> Performance Bond Amount(1) Payment Bond Amount(2) <br /> El RNV Contract No. of $ $ <br /> Bond Company <br /> Bond Number(1) Bond Number(2) <br /> TO: <br /> Ground Zero Analysis, Inc. <br /> 1172 Kansas Avenue <br /> Modesto, CA 95351 <br /> ATTN: Jenny Weese <br /> TEL : (209) 522-4119 PERMITTEE <br /> I I <br /> And subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Use a Cone Penetrating Testing (CPT) drill rig to drill 4 borings in 3 locations within State Route <br /> 4 between Post Mile 17.00 and Post Mile 17.07 as shown on the attached map to collect discrete <br /> ground samples in City of Stockton, San Joaquin County. A copy of this permit shall be placed in <br /> all vehicles involved in doing this work. All work shall conform to the approved plans, Caltrans <br /> Standard Specifications Dated 2018 and California MUTCD Dated 2014. <br /> This permit is not valid until Permittee has obtained permission from adjacent property <br /> owners, Irrination Districts, Cities, Counties or other interested parties to perform the <br /> proposed work. <br /> THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANFER WITH THE PROPERTY TO A NEW OWNER <br /> The following attachments are also included as part of this permit(Check applicable): In addition to fee,the permittee will be billed <br /> 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, if required: Permit No. <br /> ❑ Yes ® No As-Built Plans Submittal Route Slip for Locally Advertised Projects (If any Caltrans effort expended) <br /> ❑ Yes ® No Storm Water Pollution Protection Plan <br /> ❑ Yes ® No The information in the environmental documentation has been reviewed and considered prior to approval of this permit. <br /> This permit is void unless the work is complete before March 31, 2020 <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. <br /> No project work shall be commenced until all other necessary permits and environmental clearances have been obtained. <br /> APPROVED: <br /> Original:Permittee <br /> 2-Joe Valdez <br /> 1-Maintenance <br /> 1-File DAN McELHINNEY, District Director <br /> George RHODEL De CLARO, District Permit En ineer <br /> ADA NOTICE:For individuals with sensory disabilities,this document is available in alternate formats.For information,call(916)445-1233,TTY 711, or <br /> write to Records and Forms Management, 1120 N Street, MS-89,Sacramento,CA 95814. <br /> 1 of 4 <br />