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0 0 <br /> This permit is issued pursuant to all provisions of City of Tracy Municipal Code. This permit is granted upon the express <br /> condition that the Permittee shall be responsible for all claims and liabilities arising out of work performed under the permit or <br /> arising out of Permittee's failure to perform the obligations with respect to street maintenance. The Permittee shall,and by <br /> acceptance of the permit agrees to,defend,indemnify,save and hold harmless the city,its officers and employees,from and <br /> against any and all suits, claims or actions brought by any person for or on account of any bodily injuries,disease or illness or <br /> damage to persons and/or property sustained or arising in the construction of the work performed under the permit or in <br /> consequence or Permittee's failure to perform the obligations with respect to street maintenance. <br /> Permittee agrees to abide by the provisions of this permit. <br /> Brian Millman-Advanced GeoEnvironmental 10 December=s <br /> PERMITTEE'S NAME(PRINT) PERMff TEE'S SIGNATURE DATE <br /> Prior to excavation,Contractor must contact the following to have below-ground facilities located(48 hours prior to <br /> work): <br /> UNDERGROUND SERVICE ALERT <br /> Toll Free: (800)227-2600 <br /> Boyd Service Center <br /> (209)831-4420 <br /> Note: You are notified that Section 6500 of the Labor Code requires the issuance of a permit by the Division of <br /> Industrial Safety of the State of California prior to the construction of any trench or excavation which is five feet or <br /> deeper and into which a person is required to descent Excavation in city street areas without an excavation permit <br /> may be punishable by a fine. <br /> Permittee agrees that they hereby accept complete responsibility for coordination with,reporting to,and complying <br /> with the direction of, any and all boards or districts,including but not limited to,San Joaquin County Local Health <br /> District and California Regional Water Quality Control Board, or any other regulatory agency having jurisdiction or <br /> authority over soil or ground water contamination such as that currently found at the site of this work,including the <br /> preservation of the health and safety of persons working near or in any trench or excavation or on the surface of the i <br /> construction project,or any persons passing by or observing, or any persons living in the vicinity of the construction <br /> project,for any reason whatsoever that may adversely, or otherwise affect the health or safety, now and in the future, F <br /> of these persons or group of persons. <br /> Furthermore, Permittee hereby accepts complete responsibility for_dispo"sal of any petroleum affected soils,or <br /> t <br /> ground water, including reporting to and complying with the requirements of any,or all, of the stated,or any other, i <br /> regulatory agencies as discussed above. <br /> CITY INSPECTOR'S COMPLETION REPORT NUMBER- i <br /> i <br /> Date of Completion: Concrete: <br /> , <br /> Asphalt: Sidewalk: <br /> Backfill: Paving: t <br /> Size of Cut <br /> Sq. Ft Inches: Paved By.- <br /> INSPECTOR <br /> y:INSPECTOR SIGNATURE: I <br /> Remarks: i <br /> E <br /> i <br /> I <br /> i <br /> 1 <br /> I <br /> Page 2 of 2 Rev.7/13115 <br />