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• • 1 CITY OF RIPON-ENGINEERING DEPARTMENT NO. 4058 259 North Wilma Avenue,Ripon,CA 95366 2091599-2108—Fax: 2091599-2685 ENCROACHMENT PERMIT Applicant's Name: Date Submitted: November 20, 2012 Nestl6 USA, Inc.,800 North Brand Boulevard Glendale,California 91203 Contractor: Cascade Drilling, LP Nestld Consultant/Authorized Permit Agent: Address: Environmental Costs Management, Inc. Phone: 916-638-1169 3525 Hyland Avenue,Suite 200,Costa Mesa, CA 92626 Contact Name: Paul Snelgrove ECM Manager: Binayak Acharya: (661)255-1693 Phone: ECM Invoicing: Mona Mansell: (714)662-2759 License Number: 938110 Pursuant to Chapter 12.12 of the City of Ripon Municipal Cade and all the terms,conditions,and restrictions written below or printed as general or special provisions on any part of this form,and/or attached hereto. PLEASE READ THIS PERMIT CAREFULLY AND KEEP IT AT THE WORK SITE. DESCRIPTION OF PROJECT. 1.Provide a fill description of work to be done at all locations. PERMISSIONISHEREBYGRANTED TO 2.Attach hvo(2)sets ofplans ah•sketches, if applicable. Install a single monitoring well using hollow stem auger ion City of Ripon property Just west of Locust Avenue on alley and/or edge of right of way south of West Main Street and north of First Street(east of Elm)(see Attachment t). The well will be Installed to a depth of approximately 120 feet bgs. This will be well M-55A. Borehole diameter for the well will be 8",with a 2"well completed in the borehole.A flush mount well cover Installation,monument and well box will be placed over the well. Soil and water from the drilling and development activities will be contained and disposed of at a location owned by the applicant.Traffic control will be completed based on the traffic control plan employed by ECM(see Attachment 2). Cost of ROW work is included as Attachment 3 and the City is named as additional insured in Attachment 4. Estimated Value of Right-of-Way Work: $ $18,405.00 Permit Fee: 3% Plan Review: $ 552.15 3% Site Inspection: $ 552.15 1% GIS: $ 184.05 TOTAL FEE: $ 1,288.35 TO ARRANGE FOR AN INSPECTION,PHONE 209/599-2108 AT LEAST 48 HOURS PRIOR TO CONSTRUCTION. This permit shall be void unless the work herein described is completed by: 3-I-o Dalc Accepting this permit or starting work herein described,shall constitute acceptance and agreement to all the conditions and requirements of this permit. Signature of Appli can t/Permittee City Engineer(ora Itorized Agent) . IZ-(0-12 ApplicantlPer mttee or Authorized Agent Date Issued NOTE: Your attention is directed to the general provisions printed on die back of this form. This permit is to be strictly construed and no work,other than that specifically mentioned above,is hereby authorized. PERMIT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT WORK COMPLETED: BY: Date