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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date March 21, 2012 ENOTESI <br /> FFICE USE ONLY <br /> To. San Joaquin County l00�< REF# <br /> Department of Public Works CR# <br /> San Pablo Bay Pipeline company LLc TO DRIVEWAYS: <br /> (Applicant Name) %S yA wc/o Shell Pipeline Company, LP <br /> Attn: Michael Elmore, Senior Staff Land Agent (QUAD�(Mailing Address)20956 S, Wilmington Avenue <br /> Carson, California <br /> 90810 <br /> (City,State,Zip Code) <br /> 310-816-2208 <br /> (Area Code•Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Exhibit "A" - prior Encroachment Permit 67-214 <br /> Questions - Please contact Beth Bissell, Contract Document Specialist for <br /> San Pablo Bay Pipeline Company LLC <br /> 925-935-5101 <br /> The undersigned hereby applies for permission to ex vate,c nstruct and/or otherwise enc ach on County Highway Right-of Wa on <br /> the.� side of yy <br /> approximately S feet/mile�t <br /> by performing the following work(description of work): <br /> oto operate and maintain an existing 20" crude oil pipeline crossing roads at <br /> locations shown in prior Encroachment Permit 67-214, a copy of which is attached <br /> as Exhibit "A". <br /> Work wilE commence on or about for approximately days,' <br /> I,the undersigned,certify tha am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> d above in rdance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ignatu a of plicant• itie Date <br /> ewieSV.WAWASTEtrs�ceoaawE,"MWI-r"SArAW.t c iota) <br />