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STATE OF CAUFORNIA- DEPARTMEW :TRANSPORTATION <br /> ENCROACHMENT PER&Tri' Pemd i® <br /> TR-0120(NEW 9/91) 1096-6SV-0147 <br /> Dist/Co/Rte/PM <br /> l0-SJ-4-16.79 <br /> In compliance with (check one): <br /> X Your application of MARCH 11, 1996 <br /> ae <br /> Utility Notice No. of MaV 23, 1996 <br /> Fee Paid Deposit <br /> Agreement No. of $ 210 $ <br /> Pe ormanca Bon Amount Ill Payment bond Amount (2) <br /> R/W Contract No. of $ 2,000 $ <br /> Bond Company <br /> UNITED PACIFIC INSURANCE CO. <br /> gond Number (1) Bond Number (2) <br /> TO: F. WESTON U246 78 07 <br /> Y <br /> RO1 <br /> 2300 CLAYTON RD., SUITE 1580 <br /> CONCORD, CA 94520-2148 <br /> ATTN: SCOTT EMERSON-PRICE <br /> PHONE: (510) 603-7923 PERMITTEE <br /> and subject to the following, PERMISSION IS HEREBY GRANTED to: <br /> DRILL AND INSTALL ONE 10 INCH GROUNDWATER MONITORING WELL APPROXIMATELY 60 FEET <br /> DEEP WITHIN THE STATE RIGHT OF WAY, ON THE NORTH SIDE OF STATE ROUTE 4 (CROSSTOWN <br /> FREEWAY IN THE CITY OF STOCKTON. INSTALL ONE 4 INCH SCH 40 PVC CASING. PACK, SEAL <br /> AND CONCRETE GROUT WELL AS SHOWN ON THE PLANS. COMPLETE SURFACE INSTALLATION <br /> WITH A FLUSH MOUNTED 12 INCH DIAMETER TRAFFIC RATED WELL HEAD STREET BOX. <br /> A pre-job conference with the permittee, contractor, and State representative is required prior to start of <br /> work. Permittee shall contact the State representative and arrange the meeting. This meeting may be <br /> waived at the direction of the State representative. <br /> Permittee shall, prior to commencement of any work, provide the State representative with the name and <br /> phone number of the person in responsible charge of the work to be performed under this permit. <br /> In accordance with General Provision No. 6, TWO WORKING DAYS PRIOR to the start of this work, <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 cosh for. <br /> X Yes No General Provisions _ Yes X No Review <br /> _ Yes X No Utility Maintenance Provisions Yes X No Insped:on <br /> X Yes _ No Special Provisions T X Yes _____ Field Work <br /> _ Yes X No A Cal-OSHA permit required prior to beginning work; <br /> p (If any Coltrons effort expended) <br /> _ Yes X 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 NOVEMBER 30, 1996 <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 /> Orlg - Permittee APPROVED: <br /> 1 - Permit File <br /> 3 - BILL LAMASCUS <br /> Gordon A. Marts District Director <br /> BY: <br /> YY <br /> Latirie R. Jur ens, nct Permit Engineer <br /> Page 1 of 2 <br />