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02/0411,2009 14: 20 209-948-7232 CALTRAHS D10 PERMITS PAGE 02/04 <br /> STATE OF CAUFORNW DEPAP.TMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT Permit t\io. <br /> TR-0120 r R EU6i2!J00) l U-0 9-b-TY.-U O 51 <br /> sUCo,iRte/PM <br /> In compliance with (Check one): oats 10-SJ-33 171M 0.16 <br /> - 47i26r20Q9 <br /> * Your application of JanaarY 2n, 209 iFeePs;d eposn <br /> 5 322 <br /> ❑ Utility Notice N0. or Performance Bond Amount(1) Payment Band Amount(2) <br /> 0.00 0.00 <br /> ❑ Agreement No. of and Company <br /> ❑ R/W Contract No. of Bond Number(1) Id NuMW(2) <br /> i <br /> TO: Chevron Enviornmental Management Company (CEMC) <br /> 6111 Bollinger Canyon Road, BR1Y3432 <br /> San Ramon. CA 94583 <br /> PERMITTEE <br /> Attn : Sean Gehlke, 925-543-2:x53 , <br /> and subject to the following. PERMISSION IS HEREBY GRANTED to: <br /> Place advance road work ahead signs, maintain. remove and accomplish temporary <br /> flagging traffic control along State Route 33 right of xray and Welty Road <br /> Intersection in San Joaquin County, Traffic control shall be as directed by the <br /> State representative. <br /> In accordance with General Provision No . 6 , TWO WORKING DAYS PRIOR to the start of <br /> this work, Permittee shall notify the State Representative JOE VALDEZ, P. O. Box <br /> 2048 , Stockton, CA 95201 . (209 ) 948-3656 . All work requiring traffic control <br /> must apply for a closure number seven days prior to start of work. No clo�-_ures on <br /> HOLIDAYS or WEEKENDS , All work under this permit must meet with the approval of the <br /> State Representative. <br /> Failure on the Permittee's part to comply with any provision will be cause for <br /> revocation of this permit . <br /> THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANSFER WITH THE PROPERTY TO A NEW OWNER. <br /> The follo,tibng attachments are also included as part of this permit(Check applicable): <br /> 9 Yes El No General Provisions In addition to fee, the permittee will <br /> be billed actual costs for; <br /> ❑Yes ®No Utility Maintenance Provisions <br /> D Yes 0 No Storm Water Special Provisions ®Yes ❑No Review <br /> ®Yes ❑No Special Provisions ®Yes ❑No Inspection <br /> ❑Yes R No A Cal-OSHA permit if required: Permit No. ®Yes ❑No Field Work <br /> ❑Yes ®No As-Built Plans Submittal Route Slip for Locally Advertised Projects <br /> ®Yes ❑No Storm Water Pollution Prevention Plan/Water Pollution Control Plan (if any Caltrans effort expended) <br /> ❑Yes ®No The information in the environmental documentation has been reviewed and considered prior to <br /> approval or this permit <br /> This permit is void unless the work is completed before .raze <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 the other necessary permits and the environmental clearances have been obtained. <br /> PERMIT ENGINEER:Eddie Diwita APPROVED: <br /> COPIES To: <br /> original-Perm luee <br /> 1-WintenancE KomeAlise,Disinct Director <br /> 2-Joe Valdez 6Y: <br /> File <br /> ! N£LSON SA O,PDiStrict Permit Engineer <br /> FM 91 14118(010 PermltApp-) �% <br />