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STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.2/98) <br /> =No. 6 <br /> In compliance with (Check one): Dist/Co/Rte/PM <br /> Your application of 10-SJ-33-0.30 <br /> ® May 3, 2010 <br /> Date <br /> ❑ Utility Notice No. of May 26, 2010 <br /> ❑ Agreement No. Of Fee Paid Deposit <br /> 820.00 <br /> ❑ RM/Contract No. Of <br /> Performance Bond Amount(1) Payment Bond Amount(2 <br /> $ <br /> Bond Company <br /> TO: 7ond5­­N�umber Bond Number(2) <br /> r — <br /> Chevron Environmental Management Company-� <br /> 345 S. Redwood Drive <br /> Reedley, CA 93654 <br /> Affn : William Slow* <br /> TEL : (559) 638-7655 <br /> and subject to the following, PERMISSION IS HEREBY GRANTED to: PERMITTEE <br /> Do temporary vertical soil borings to a depth of about 50' in two locations for the <br /> collection of soil groundwater samples along the shoulder of State Highway 33 right of <br /> way at about 700' north of Welty Road in the town of Vernalis. Bores shall be properly <br /> abandoned after samples are taken by filling it with Portland cement per requirement of <br /> San Joaquin County Environmental Health Department. <br /> In accordance with General Provision No. 6, SEVEN WORKING DAYS PRIOR to the <br /> start of this work, Permittee shall notify the State Representative JOE VALDEZ, P. O. <br /> Box 2048, Stockton, CA 95201, 209 948-3656. All work under this permit must meet <br /> The following attachments are also included as part of this permit <br /> (Check applicable): <br /> In addition to fee,the permittee will be billed <br /> actual costs for: <br /> 0Yes Yes ❑ No General Provisions Yes ❑ No Review <br /> ® NO Utility Maintenance Provisions <br /> ® Yes ❑ NO Special Provisions T ® Yes ❑ No Inspection <br /> ❑ ® ❑ <br /> Yes ® NO A Cal-OSHA permit required prior to beginning work; Yes No Field Work <br /> # (If 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 expires on or before November 30, 2010. <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized. <br /> No project work shall be commenced until all other necessary permits and environmental clearances have been obtained. <br /> 1 —Permittee APPROVED: <br /> 2—R.Afzal <br /> 1 —Maintenance <br /> 1 —Z. Nogueira ROSS CHITTENDEN, District Director <br /> 1—File BY: <br /> Pete — <br /> FM 91 1436 �---- <br /> NELSON MAGSAYO, District Permit Engineer <br /> _ <br />