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CITY OF RIPON-ENGINEERING DEPARTMENT NO. <br /> 259 North Wilma Avenue,Ripon,CA 95366 <br /> 209/599-2108—Fax: 209/599-2685 <br /> ENCROACHMENT PERMIT <br /> Applicant's Name: Date Submitted: November 13, 2009 <br /> Nestle USA, Inc. 800 North Brand Boulevard Boart Longyear: : 1333 West 9th Street, <br /> Glendale, California 91203 Contractor: _ Upland California, 91786 <br /> ConsuAddress: Environmental Cost Management, Inc. Boart Office# 909-946-1605 <br /> Phone: <br /> 3525 Hyland Avenue, Suite 200 <br /> Costa Mesa, CA 92626 Contact Name: ECM: Binayak Acharya <br /> Phone: ECM Contact: (661) 255-1693 License Number: C-57 License: 694686 <br /> Pursuant to Chapter 12.12 of the City of Ripo`n.-Municipal Code and all the terms,conditions,and restrictions <br /> written below or printed as general or special provisions on any part of this form,and/or attached hereto. <br /> PLEASE READ THIS PERWr CAREFULLY AND KEEP rr AT THE WORK SITE. <br /> DESCRIPTION OF PRO LEC_T_• 1.Provide a full description of work to be done at all locations. <br /> PERWSSIONIS REREB Y GRANTED TO 2.Attach two(2)sets of plans or sketches,if applicable <br /> Installation of a 2-inch groundwater monitoring well in Fifth Street,to a depth of approximately 165 feet,with a borehole diameter of 4 inches <br /> Drilling method is truck mounted sonic rig- Flush mount well cover installation,monument and well box will be placed over well <br /> Please see the proposed boring location on the attached map.The actual location may change slightly depending on access and utility locations <br /> Traffic control on this side street will be completed based on the driller's traffic control plan,which includes coning off the drilling area and the area <br /> leading up to the drill rig on either side.Caution tape will be used as well to indicate the work area. <br /> Soil an wat r from the dda1Iin and development activities will be contained and disposed of at a location owned by the applicant. <br /> CtIRMaER 2 s E SHA L mars gV.3* M <br /> 14E VA ; <br /> Fox .6 I.A — Ui2L; <br /> TO ARRANGE FOR AN INSPECTION,PRONE 209/599-2108 AT LEAST AMOURS PRIOR TO CONSTRUCTION <br /> This permit shall be void unless the work herein described is completed by: February 10, 2010 <br /> Date <br /> Accepting this permit or starting work herein described,shall constitute acceptance and agreement to all the <br /> conditions and requirements of this permit. <br /> Signature of Applicant/Permittee City Engineer(or authorized Agent) <br /> ApplicanVFennittee or Authorized Agent Date Issued <br /> NOTE: Your attention is directed to the general provisions printed on the back of this form. This permit is to be strictly <br /> construed and no work,other than that specifically mentioned above,is hereby autha died. <br /> PERK UT NOT VALID UNLESS EXECUTED BY CITY ENGINEER OR HIS AGENT <br /> WORK COMPLETED: BY: <br /> WhRe FOe Yellowanspeetor PlInk,Appllaant <br /> Ra.Not <br />