Form TR-0131 "Consent Letter" - California

What Is Form TR-0131?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TR-0131 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form TR-0131 "Consent Letter" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONSENT LETTER
Maintenance Stations' contact information can be found at: http://www.dot.ca.gov/hq/row/wireless/maint/
TR-0131 (REV. 7/2013)
NAME OF APPLICANT AND/OR ORGANIZATION
BUSINESS ADDRESS
CITY/STATE/ZIP
BUSINESS TELEPHONE NUMBER
LOCATION OF WORK (COUNTY/RTE/PM, CROSS STREETS)
DESCRIPTION OF WORK
Removal of U.S. Forest Service's or Bureau of Land Management's minor forest products (firewood, posts,
shakeboards, shake and shingle bolts, or split products, in quantities exceeding 20 cubic feet in volume, and
Litter removal
burlwood or stumps in quantities of two or more). A permit issued by USFS or BLM is required prior to the
issuance of this consent letter, when removing minor forest products from Caltrans R/W within USFS or BLM
Salvage spilled material
boundaries.
Donated landscape materials
Estimated amount:
Other
Vegetation control (weed control, mowing grass or brush/seedlings)
Pine
Cedar
Fir
Other (Describe)
SAFETY REQUIREMENTS FOR PARTICIPANTS
Do not work on the roadway or shoulders, on bridges, in tunnels or near railroad tracks.
Do not cross freeway traffic lanes on foot. Use caution when crossing conventional highways. Use crosswalks and signals where available.
Face oncoming traffic as you work and keep an eye on traffic. Be prepared to move quickly, if necessary.
Discontinue work before dusk. Do not work when fog or other conditions reduce visibility for drivers.
Do not work when roadway is wet or icy.
Do not touch or remove materials which you suspect may be toxic or hazardous. Items to avoid include powders, chemicals, smelly substances, suspicious packages, chemical
drums or containers, weapons, syringes or hypodermic needles, dead animals and broken glass. Notify the Department or law enforcement (California Highway Patrol, Sheriff, etc) of
the location of weapons or suspected toxic substances immediately.
Do not compact trash bags. Injuries from broken or jagged objects may occur.
Wear hard hats, either ANSI Class II or III compliant vests, safety glasses or goggles and other personal safety equipment as advisable.
Wear long pants and substantial leather shoes or boots with ankle support.
Watch your footing and stay off steep slopes, drainage facilities or places from which you might fall.
Do not use portable music devices that require the use of headphones or earbuds.
Do not run, throw objects or engage in horseplay or any other activity which may distract drivers.
Do not consume alcoholic beverages or drugs before entering or while on the roadside.
Be alert where snakes may be located. Also be alert for stinging insects and poisonous plants (e.g. poison oak).
TERMS AND CONDITIONS
It is expressly understood that the work to be performed is to be undertaken by yourself, your organization or by volunteers acting for and on behalf of themselves, yourself and your
organization and that yourself, your organization, and said volunteers are not and shall not be considered employees of the State of California, or of the Department of
Transportation.
The State of California and its officers and employees shall not be liable for any death, injury or property damage claims which arise from any activities which are the subject of this
letter of consent that may have been reasonably prevented by you, your organization or those persons employed by or acting in your behalf. If any claims arise out of the foregoing,
you shall defend, indemnify and save harmless the State of California and its officers and employees from the same.
This Consent Letter or a copy thereof shall be kept at the site of the work and must be shown to any representative of the Department of Transportation or law enforcement officer on
demand. Work shall be suspended if a complete copy of this Consent Letter is not available at the job site.
All work shall be conducted in conformance with the above "Safety Requirements For Participants".
All work shall be conducted during daylight hours.
All work shall be performed on the date(s) indicated below.
Traffic control is prohibited.
Work shall not be performed within 6 feet of traffic lanes, within center dividing strips, upon bridges, culverts, or structures of any kind unless specifically approved by
the Department's Representative. An Encroachment Permit is required for all other proposed activities not covered by this Consent Letter.
This Consent Letter is invalidated if the applicant has not obtained all permits necessary and required by law.
APPLICANT'S NAME
APPLICANT'S SIGNATURE
DATE
FOR CALTRANS USE ONLY
Permission is hereby granted to enter onto State Highway
to conduct a
day(s)**
on
, 20
, subject to the terms and conditions.
**Approval by the Maintenance Area Superintendent is required for one day activities.
**Approval by the Deputy District Director-Maintenance is required for multiple dates (maximum of 3 consecutive calendar days).
DEPARTMENT REPRESENTATIVE'S NAME
TITLE
PHONE
DEPARTMENT REPRESENTATIVE'S SIGNATURE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 654-6410, TTY 711, or write to
ADA Notice
Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONSENT LETTER
Maintenance Stations' contact information can be found at: http://www.dot.ca.gov/hq/row/wireless/maint/
TR-0131 (REV. 7/2013)
NAME OF APPLICANT AND/OR ORGANIZATION
BUSINESS ADDRESS
CITY/STATE/ZIP
BUSINESS TELEPHONE NUMBER
LOCATION OF WORK (COUNTY/RTE/PM, CROSS STREETS)
DESCRIPTION OF WORK
Removal of U.S. Forest Service's or Bureau of Land Management's minor forest products (firewood, posts,
shakeboards, shake and shingle bolts, or split products, in quantities exceeding 20 cubic feet in volume, and
Litter removal
burlwood or stumps in quantities of two or more). A permit issued by USFS or BLM is required prior to the
issuance of this consent letter, when removing minor forest products from Caltrans R/W within USFS or BLM
Salvage spilled material
boundaries.
Donated landscape materials
Estimated amount:
Other
Vegetation control (weed control, mowing grass or brush/seedlings)
Pine
Cedar
Fir
Other (Describe)
SAFETY REQUIREMENTS FOR PARTICIPANTS
Do not work on the roadway or shoulders, on bridges, in tunnels or near railroad tracks.
Do not cross freeway traffic lanes on foot. Use caution when crossing conventional highways. Use crosswalks and signals where available.
Face oncoming traffic as you work and keep an eye on traffic. Be prepared to move quickly, if necessary.
Discontinue work before dusk. Do not work when fog or other conditions reduce visibility for drivers.
Do not work when roadway is wet or icy.
Do not touch or remove materials which you suspect may be toxic or hazardous. Items to avoid include powders, chemicals, smelly substances, suspicious packages, chemical
drums or containers, weapons, syringes or hypodermic needles, dead animals and broken glass. Notify the Department or law enforcement (California Highway Patrol, Sheriff, etc) of
the location of weapons or suspected toxic substances immediately.
Do not compact trash bags. Injuries from broken or jagged objects may occur.
Wear hard hats, either ANSI Class II or III compliant vests, safety glasses or goggles and other personal safety equipment as advisable.
Wear long pants and substantial leather shoes or boots with ankle support.
Watch your footing and stay off steep slopes, drainage facilities or places from which you might fall.
Do not use portable music devices that require the use of headphones or earbuds.
Do not run, throw objects or engage in horseplay or any other activity which may distract drivers.
Do not consume alcoholic beverages or drugs before entering or while on the roadside.
Be alert where snakes may be located. Also be alert for stinging insects and poisonous plants (e.g. poison oak).
TERMS AND CONDITIONS
It is expressly understood that the work to be performed is to be undertaken by yourself, your organization or by volunteers acting for and on behalf of themselves, yourself and your
organization and that yourself, your organization, and said volunteers are not and shall not be considered employees of the State of California, or of the Department of
Transportation.
The State of California and its officers and employees shall not be liable for any death, injury or property damage claims which arise from any activities which are the subject of this
letter of consent that may have been reasonably prevented by you, your organization or those persons employed by or acting in your behalf. If any claims arise out of the foregoing,
you shall defend, indemnify and save harmless the State of California and its officers and employees from the same.
This Consent Letter or a copy thereof shall be kept at the site of the work and must be shown to any representative of the Department of Transportation or law enforcement officer on
demand. Work shall be suspended if a complete copy of this Consent Letter is not available at the job site.
All work shall be conducted in conformance with the above "Safety Requirements For Participants".
All work shall be conducted during daylight hours.
All work shall be performed on the date(s) indicated below.
Traffic control is prohibited.
Work shall not be performed within 6 feet of traffic lanes, within center dividing strips, upon bridges, culverts, or structures of any kind unless specifically approved by
the Department's Representative. An Encroachment Permit is required for all other proposed activities not covered by this Consent Letter.
This Consent Letter is invalidated if the applicant has not obtained all permits necessary and required by law.
APPLICANT'S NAME
APPLICANT'S SIGNATURE
DATE
FOR CALTRANS USE ONLY
Permission is hereby granted to enter onto State Highway
to conduct a
day(s)**
on
, 20
, subject to the terms and conditions.
**Approval by the Maintenance Area Superintendent is required for one day activities.
**Approval by the Deputy District Director-Maintenance is required for multiple dates (maximum of 3 consecutive calendar days).
DEPARTMENT REPRESENTATIVE'S NAME
TITLE
PHONE
DEPARTMENT REPRESENTATIVE'S SIGNATURE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 654-6410, TTY 711, or write to
ADA Notice
Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.