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! P <br /> STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV.2198) Permit No. <br /> 1010-6SV-0256 <br /> DIst/Co1Pte/PM <br /> In compliance with (Check one): <br /> 10-SJ-33-0.30 <br /> ® Your application of May 3 2010 <br /> Date <br /> ❑ Utility Notice No. of May 26, 2010 <br /> Fee Paid Deposit <br /> ❑ Agreement No. of $ $ 820.00 <br /> Performance Bond Amount(1) Payment Bond Amount(2 <br /> ❑ RAN Contract No. of $ $ <br /> Bond Company <br /> Bond Number(1) Bond Number(2) <br /> TO: <br /> r � <br /> Chevron Environmental Management Company <br /> 345 S. Redwood Drive <br /> Reedley, CA 93654 <br /> Aftn : William Slow& <br /> TEL : (559) 638-7655 <br /> I I <br /> PERMITTEE <br /> and subject to the following, PERMISSION IS HEREBY GRANTED to: <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 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 ® No Utility Maintenance Provisions ® Yes ❑ No Inspection <br /> ® Yes ❑ No Special Provisions T ® Yes ❑ No Field Work <br /> ❑ Yes ® No A Cal-OSHA permit required prior to beginning work; <br /> # (!f 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 /> e rm it. <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 B <br /> G/ d <br /> Pete NELSON MAGSAYO, District Permit Engineer <br /> FM 91 1436 <br />