Form TR-0168 "Caltrans/Electric Utility Tree Removal Request" - California

What Is Form TR-0168?

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 June 1, 1998;
  • 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-0168 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-0168 "Caltrans/Electric Utility Tree Removal Request" - California

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Page 1 of 2 Front
CALTRANS/ELECTRIC UTILITY TREE REMOVAL REQUEST
TR-0168 (Rev (6/1998)
The Electric Utility uses this form to request the removal of trees located on the Caltrans right of way and the authorized
under Section IIIB of the Electric Utility Tree Pruning and Removal Provisions of the encroachment permit. The Electric
Utility authorized representative completes this portion of the removal request. At least one legible photograph showing
the tree(s) to be removed shall be submitted with this request.
TO: CALTRANS DISTRICT LANDSCAPE SPECIALIST
DATE
FROM: ELECTRICAL UTILITY
PERMIT NUMBER
COUNTY
ROUTE
POST MILE
Location of Tree:
Local Address:
Physical Location:
DIAMETER
COMMON NAME
Description of Tree to be Removed:
SPECIES
GENERAL CONDITION
Low Species Value
Mutually Agreed Potential Hazard
Reason for Removal Request:
Poor Health
Severe Structural Defect
Explain:
Attached is a photograph of the tree(s) to be removed, marked with arrows or "X"
UTILITY AUTHORIZED REPRESENTATIVE
TELEPHONE NO.
TITLE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or
ADA Notice
write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Page 1 of 2 Front
CALTRANS/ELECTRIC UTILITY TREE REMOVAL REQUEST
TR-0168 (Rev (6/1998)
The Electric Utility uses this form to request the removal of trees located on the Caltrans right of way and the authorized
under Section IIIB of the Electric Utility Tree Pruning and Removal Provisions of the encroachment permit. The Electric
Utility authorized representative completes this portion of the removal request. At least one legible photograph showing
the tree(s) to be removed shall be submitted with this request.
TO: CALTRANS DISTRICT LANDSCAPE SPECIALIST
DATE
FROM: ELECTRICAL UTILITY
PERMIT NUMBER
COUNTY
ROUTE
POST MILE
Location of Tree:
Local Address:
Physical Location:
DIAMETER
COMMON NAME
Description of Tree to be Removed:
SPECIES
GENERAL CONDITION
Low Species Value
Mutually Agreed Potential Hazard
Reason for Removal Request:
Poor Health
Severe Structural Defect
Explain:
Attached is a photograph of the tree(s) to be removed, marked with arrows or "X"
UTILITY AUTHORIZED REPRESENTATIVE
TELEPHONE NO.
TITLE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or
ADA Notice
write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Page 2 of 2 Back
CALTRANS/ELECTRIC UTILITY TREE REMOVAL REQUEST
TR-0168 (Rev (6/1998)
This portion of the request form is to be completed by the District Landscape Specialist. The form is used to document
the approval of a tree removal request and to verify that the removal was authorized under: Section IIIB, of the Electrical
Utility Tree Pruning and Removal Provisions. Only trees which do not require replacement, compensation or mitigation
planting may be authorized for removal be the Caltrans District Landscape Specialist. A copy of the request must be
forwarded to the District Landscape Architect.
Removal checklist. Removal cannot be approved by the District Landscape Specialist if a yes answer is given to any of
the following questions. If a yes answer is given for any of the following questions then the request shall be forwarded to
the District Landscape Architect for review.
1. Does the tree provide a highway screen for adjacent development?
YES
NO
If yes, explain:
2. Does the tree provide wildlife habitat?
YES
NO
If yes, explain:
3. Does the tree provide any other important landscape function?
YES
NO
If yes, explain:
Only trees which meet the following criteria may be authorized for removal by the District Landscape Specialist
Low Species Value
Mutually Agreed Potential Hazard
Tree Removal Criteria:
Poor Health
Severe Structural Defect
Explain:
Approved:
YES
NO
If no, explain:
DISTRICT LANDSCAPE SPECIALIST
TELEPHONE NO.
DATE
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