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i. <br /> STATE OF CALIFORNIA a DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERM <br /> TR-0120(REV.2198) Permit No. <br /> 1010-6SV-0024 MID <br /> Dist/Co/Rte/PM <br /> In compliance with (Check one): <br /> 10-SJ-4-17.27 <br /> Your application of JANUARY 19, 2010 <br /> Date <br /> Utility Notice No. of JANUARY 21, 2010 <br /> Fee Paid Deposit <br /> Agreement No. of $ $492 <br /> Performance Bond Amount(1) Payment Bond Amount(2) <br /> 0 RIVV Contract No. of $ $ <br /> Bond Company <br /> Bond Number(1) Bond Number(2) <br /> TO: <br /> MICHAEL& SHARON OLIVAREZ <br /> 540 WEST SCOTTS AVENUE <br /> STOCKTON, CA 95203 <br /> i <br /> i <br /> TEL : (209)481-5360 <br /> 1 I <br /> PERMITTEE <br /> and subject to the following, PERMISSION IS HEREBY GRANTED to: <br /> Install, maintain, and sample one monitoring well (MW-11), as shown on the attachments, within <br /> State Highway 4 right of way eastbound off-ramp approximately 300 S. California Street in the <br /> City Stockton in San Joaquin County. Upon the completion of work, the borings shall be <br /> abandoned in accordance to California Department of Transportation Standards and <br /> Specification with an approval of the State Field Representative. A copy of this permit shall be <br /> placed in the vehicles involved in doing this work. Permittee shall notify the State Field <br /> Representative in the area before doing any work under this permit. <br /> In accordance with General Provision No. 6, SEVEN WORKING DAYS PRIOR to the start of <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 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 required prior to beginning work; <br /> # (!f any Caltrans effort expended) <br /> Yes ® No <br /> The information in the environmental documentation has been reviewed and is considered prior to approval of this <br /> permit. <br /> This permit is void unless the work is complete on or before DECEMBER 31, 2011. <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 pe its and environmental clearances have been obtained. <br /> ORIGINAL-Permittee APPROVED: <br /> 2—JIOSEPH A.VALDEZ ( ) -+4 <br /> I-MAINTENANCE ROSS CHITTENDEN, District Director <br /> I-ZELIE NOGUEIRA BY: <br /> Betty TamaeEL N MA SAYO, District Permit En ineer f <br /> 1 10 <br /> FM 81 1438 <br /> i <br />