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STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.2198) Permit No. <br /> 1014-NSV-0176 <br /> D1SUCo/RteIPM <br /> In compliance with(Check one): 10-SJ-205-2.714.9 <br /> Your application of MARCH 20,2014 <br /> Date <br /> ❑ Utility Notice No, of MARCH 21, 2014 <br /> Fee Paid Deposit <br /> ❑ Agreement No. of $ EXEMPT $ <br /> Performance Bond Amount(1) Payment Bond Amount(2) <br /> ❑ RNV Contract No. of $ $ <br /> Bond Company <br /> Bond Number(1) Bond Number(2) <br /> TO: _ <br /> CI OF F TRACY <br /> 325 CIVIC CENTER PLAZA <br /> TRACY,CA 95376 <br /> ATTN: LAM TRAN CRUZ <br /> TEL : (209)831-6452 <br /> I I <br /> PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Conduct Civil Engineering Surveys of geotechnical investigations for the proposed bridge and <br /> for evaluating the pavement section along the Interstate 205 right of way, as shown on the <br /> attachment, approximately 3200' south of Byron Road in the City of Tracy in San Joaquin <br /> County. Three explorations will be conducted to a depth of 120' using 8"diameter augers. Two <br /> short cores/borings will be drilled to measure existing pavement section in the shoulder areas. <br /> All work shall be done in accordance with the State Standard and Specifications with an <br /> approval of the State Field Representative. A copy of this permit shall be placed in all vehicles <br /> involved in doing this work. This Permit does not allow to have a lane closures on the mainline <br /> of Interstate 205. Permittee shall notify the State Representative of the area before doing <br /> 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): acluat 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,TR-400 ® 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 expires on or before DECEMBER 31, 2014. <br /> This permit is to be strictly construed and no otherwork other than specifically mentioned is hereby authorized. <br /> No project work shall be commenced until all other necessary pe its and environmental clearances have been obtained. <br /> ORIGINAL-Permittee APPROVED: <br /> 1 -File <br /> 2 ea.—JOSEPH A.VALDEZ <br /> I-MAINTENANCE AMARJEET BENIPAL,Acting, District Director <br /> I-PIO N�Z <br /> - s-27 -20/y <br /> Betty Tamae MAGSAYO, D Z t Perrrt En ineer <br /> FM 91 1436 <br />