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i STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT TR-0120(REV.2/98) Permit No- 101 1-6SV-0285 o.1011-6SV-0285 _ Dist/Co/Rte/PMIn compliance with (Check one): 10-SJ-33-0.04/0.05 ® Your application of June 17, 2011 J Date ❑ Utility Notice No. Of June 27, 2011 Fee Paid Deposit ❑ Agreement No. of $ $ 492.00 Performance Bond Amount(1) Payment Bond Amount(2) ❑ RAN Contract No. Of $ $ Bond Company TO: Bond Number(1) Bond Number(2) 4 Chevron on Environmental Management Company c/o Science Applications International Corporation 1000 Boadway, Suite 675 Oakland, CA 94607 1 Attn: Sean Gehlke TEL : (510) 466-7148 I I PERMITTEE and subject to the following, PERMISSION IS HEREBY GRANTED to: Drill four (4) vertical soil borings to collect soil and groundwater samples along the easterly shoulder of State route 33 right of way located 0.25 mile south of Welty Road in San Joaquin County. Soil borings shall be removed in compliance with the Department of Water Resources Standards by pressure grouting with near cement to the ground surface. A copy of this permit shall be placed in the vehicles involved in doing this work. Traffic control shall be done as directed by the State representative_ In accordance with General Provision No. 6, SEVEN WORKING DAYS PRIOR to the start of this work, Permittee shall notify the State Representative JOE VALDEZ, P. O. The following attachments are also included as part of this permit In addition to fee,the permittee will be billed (Check applicable): actual costs for: ® Yes ❑ No General Provisions ® Yes ❑ No Review ❑ Yes ® No utility Maintenance Provisions ® Yes ❑ No Inspection ® Yes ❑ No Special Provisions T ® Yes ❑ No Field Work ❑ Yes ® No A Cal-OSHA permit required prior to beginning work; # (If any Caltrans effort expended) ❑ Yes ® NO The information in the environmental documentation has been reviewed and is considered prior to approval of this permit. This permit is void unless the work is completed before December 31, 2011. This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. No project work shall be commenced until all other necessary permits and environmental clearances have been obtained. Original—Permittee APPROVED: 1 —Maintenance 1-PIO(Zelie) 2-Joe Valdez File CARRIE BOWEN, District Director BY: eddie LSON MAGSAYO, District Permit En ineer ....a,..-.....o - ...i.«...s.—...w.�-.+....�.....u.w..-.«.-........-i...�....»...u...... .w.-....✓....�......r:...-..-.e--...-....�.....-...•-....«..w.« ................u-.......................w....w...�.........r..a..r � F