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03/25/2004 16:53 209-948 232 CAL RAMS D10 PE TS PAGE 04/07 <br /> STATE OF CALIFORNIA■DEPARTME., JF TRANSPORTATION <br /> ` ENCROACHMENT PERMIT j <br /> TR-0120(REV.2198) Permit Na. — - <br /> 100"SV-0240 <br /> DistlCori taro <br /> In Compliance with (Check one): <br /> 7Q�SJ-1:}-16.43 <br /> ® Your application of MARCH 25,2004 <br /> Date <br /> ❑ Utility Notice No, of MARCH 25,x004 <br /> Fee Paid Dept sit <br /> ❑ <br /> Agreement No, of 82 <br /> P9ftrmance Fond Amount(1) Peyn gent Bond Amount(2) <br /> ❑ PJW Contract No. of $2000.00 $ <br /> Bond Comp2ny <br /> American Contractors fm en atity Comipany <br /> Bong Number(1) 6t:nd Number(2)-' <br /> TO: 197397 <br /> WILLIAM GRAFFIGNA JR. J <br /> 837 SHAW ROAD <br /> STOCKTON,CA 85215 <br /> TEL.: (209)334-3233 <br /> , PERMITTEE <br /> and subject to the following,PERMISSION IS HEREBY GRANTED to <br /> Install, monitor, maintain, and sample well for San Jo uin County Environmemtal Heal-:h Department <br /> approximately 53 feet west of South Ham Lane at State Highway 12 right of way in the City of Lodi in San <br /> Joaquin County. Upon the completion of groundwater monitoring, the well will be abandoned by pressure <br /> grouting with near cement to the ground surface and the asphalt will be mt=ed to the original or better <br /> condition. The well drilling and installation maybe conducted at night to reduce the impact to traffic. A copy <br /> of this permit shall be placed in the vehicles involved in doi g this work. <br /> In accordance with General Provision No. 6, TWO WO NG DAYS PlUOR to the stare of this work, <br /> P=nittee shall notify the State Representative MARCEI, DE LA CRUZ, P.Q. Box 2048 Stockton, CA <br /> 95201, (209) 948-3656. All work under axis permit must meet with the approval of the State Re.3resentative. <br /> The fdlov4ng 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 rZ No Utility Maintenance Provisions Yes ❑ No Inspection <br /> M Yes ❑ No special Provisions T Yes ❑ No Field Work <br /> ❑ Yes J�Q NO A Cal-OSHA permit required prior to beginningwork; <br /> 0 (IF any Caltrans effort expended) <br /> ❑ Yes Z No The infomlation in the environmental documentatl Dn has been reviewed an J 4s Considered prior to;ipproval of Oils <br /> permit. <br /> This permit is void unless the work is complete before DECEMBER-31,2006. _ <br /> This permit Is to be strictly construed and no other work other than specifically mentioned is hereby authoroad. <br /> Na o act work shall be oommonmed until all other neaassa rmitg and environmental clearances have been obtaineq. <br /> 1 -Pormitt a APPROVED: <br /> 1 -File <br /> 3-Marcel Ds La Crux <br /> JULIE DUN ING, District Directo ming) ._ <br /> L3Y: <br /> Bettyramae ME ict PertTlit Engineer / <br /> FM 91 14313 <br />