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City of <br /> �Wlllic Works Department <br /> 390 Towne Centre Drive <br /> Lathrop Ca,95330 <br /> Main (209) 941-7430 <br /> Permit No. 2012-17 Fax (209) 941-7449 k <br /> ENCROACHMENT PERMIT (7 5-0 <br /> Applicant Information: 2. <br /> Applicant Name: Advanced GeoEnvironmental <br /> Date: October 11, 2012 <br /> Mailing address: 837 Shaw Road City:_ Stockton, CA Zip: 95215 <br /> Encroachment Location; 15615 South 7"' Street/Langston's Market j <br /> h <br /> Contractor Information: <br /> Contractor: —Al-Well Abandonment Construction Manager: Brian Millman <br /> f <br /> Address: 9245 Beatty Drive Suite A Contractor Phone# : (209)482-8556 <br /> City: Sacramento. CA_Zip: 95826_ License No.: 848359 <br /> Bond Required Yes No <br /> AMOUNT CHECK/BOND# Release of Bond Approved By: <br /> Two(2)24-HOUR CONTACTS - NAME & PHONE NO: Brian Millman (209) 482-8556 <br /> (MANDATORY) <br /> Robert Marty (209) 969-3239 <br /> PERMISSION IS HEREBY GRANTED TO: <br /> Destroy for (4)groundwater monitoring wells by over-drilling the wells to their total depths using a hollow-stem <br /> auger limited access drilling rig. Wells A4W 1 and MW-2 are 4-inch diameter wells, and wells A4W-7&MW-8 are 2- <br /> inch diameter wells. Compliance with Son Joaquin County Department of Health is required. <br /> CONTRACTOR MUST CONTACT PW INSPECTOR AT LEAST 24 HOURS PRIOR TO <br /> CONSTRUCTION AT (209) 992-0701. <br /> i <br /> To do work in the City right of way as shown on attached application you are subject to all the provisions on any part of this form, <br /> and or attached hereto. <br /> Your attention is directed to the general provisions attached to this permit. This permit is to be strictly adhered to <br /> and no work other that specifically mentioned above is hereby authorized. <br /> - This permit shall be void unless the work hereunder contemplated shall have been completed by: January 11,2013. <br /> Accepting this permit or starting work hereunder shall constitute acceptance and agreement to all conditions and requirements of <br /> this permit, Iff <br /> Director of Public Works: Signature of Applicant: <br /> GLENN GEBHARDT <br /> Office Copy— White Inspectors Copy—Yellow Applicant's Copy - Blue <br />