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•• <br />STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION <br />ENCROACHMENT PERMIT <br />TR-0120 (REV. 6/2012) <br />OCT 1 2 REC.° <br />Permit No <br />1017-6MW-0537 <br />In compliance with (Check one): <br />Your application of September 22, 2017 <br />El Utility Notice No. of <br />Dist/Co/Rte/PM <br />10-SJ-33-3.50 <br />Date <br />September 26, 2017 <br />Fee Paid <br />111 Agreement No. of <br />Deposit <br />Performance Bond Amount (1) Payment Bond Amount (2) <br /> R/W Contract No of <br />Bond Company <br />Bond Number (1) Bond Number (2) <br />Ground Zero Analysis, Inc. <br />1172 Kansas Ave. <br />TO: Modesto, CA 95351 <br />ATTN: Gregory Stahl <br />TEL : (209) 522-4119 , PERMITTEE <br />And subject to the following, PERMISSION IS HEREBY GRANTED to: <br />Enter into the State right of way to destruct an existing well MW-4 on State Route 33 at PM 3.50 <br />as shown on the attached plans Near Tracy, San Joaquin County. The location will be restored to <br />its original condition. This Permit also allows to conduct Traffic Control. All sign placements shall <br />be done in conformance to the 2014 California Manual on Uniform Traffic Control Devices <br />(MUTCD). All work shall be done in accordance to State Standards and Specifications with an <br />approval of the State Field Representative. <br />In accordance with General Provision No. 6, SEVEN (7) WORKING DAYS PRIOR to the start of <br />this work, Permittee shall notify the State Representative JOE VALDEZ, (209) 948-3656 or by <br />THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANFER WITH THE PROPERTY TO A NEW OWNER <br />The following attachments are also included as part of this permit (Check applicable): <br />Z Yes El No General Provisions <br />Yes Z No Utility Maintenance Provisions <br />Z Yes El No Special Provisions T, TR-400 <br />Ei Yes Z No A Cal-OSHA permit, if required: Permit No. <br />Yes Z No As-Built Plans Submittal Route Slip for Locally Advertised Projects <br />Yes Z No Storm Water Pollution Protection Plan <br />In addition to fee, the permittee will be billed <br />actual costs for: <br />Z Yes D No Review <br />Z Yes No Inspection <br />Z Yes No Field Work <br />(If any Ca/trans effort expended) <br /> <br />Z Yes No The information in the environmental documentation has been reviewed and considered prior to approval of this permit. <br />This permit is void unless the work is complete before February 28, 2018 <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 />APPROVED: <br />DENNIS T. AGAR, District Director <br />a-e- <br />/7°17 George NELSON MAGSAYO, District Permit En ' r <br />ADA NOTICE: For Individuals with sensory disabilities, this document is availablf)amRernateformats. For information, call (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N <br />Street MS-89 Sacramento CA 95814 <br />1 of 5 <br />Original: Permittee <br />2-Joe Valdez <br />1-Maintenance <br />1-File <br />1-P10