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STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT ,F <br /> TR-0120(REV.W98) Permit No. <br /> 1004 6TK-0047 <br /> DISVCvfRtelPM <br /> In compliance with (Check one): <br /> ® <br /> Your application of JANUARY 15,2004 10-SJ-580-13.38/13.69 <br /> Date <br /> ❑ utility Notice No. of JANUARY 22,2004 <br /> Fee Paid Depogit <br /> ❑ Agreement No, of $ $246 <br /> Performance Bond Amount(1) Payment Bond Amount <br /> ❑ RM Contract No. of $ $ <br /> Bond Company <br /> Bond Number(1) Bond Number(2) <br /> TO: _ <br /> ARCO T� <br /> C/O STATUS ENVIRONMENTAL, INC. <br /> 3330 CAMERON PARK DRIVE, SUITE 550 <br /> CAMERON PARK, CA 95682 <br /> ATTN: SCOTT BITTINGER <br /> TEL. : (530) 576 2062 <br /> I , <br /> PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to: <br /> Install roadwork sign on the 1-580 northbound off-ramps and southbound off-ramp to <br /> warn public traffic of the road work ahead. <br /> In accordance with General Provision No. 6, TWO WORKING DAYS PRIOR to the start <br /> of this work, Permittee shall notify the State Representative MARCEL DE LA CRUZ, <br /> P.O. Box 2048 Stockton, CA 95201, (209) 948-3656. All work under this permit must <br /> meet with the approval of the State Representative. <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 <br /> ❑ Yes ® No Inspection <br /> Yes No Special Provisions T <br /> ❑ ® 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 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 completed before JULY 31,2004. <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authofted. <br /> No project work shall be commenced until all other necessary De !is and environmental clearances have been obtained. <br /> 1 -Pennine APPROVED: <br /> 1-File <br /> 3—M.DE LA CRUZ <br /> JULIE DUNNING, Acring District Director <br /> BY&EN& <br /> Pere <br /> Lpi trict Permit neer <br /> CM Pi 14.35 J <br /> 90/40 3DVd JUVO ON sniv is S0099LWE6 VT:60 b00Z/TT/E0 <br />