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Mar. 18. 2014 1 : 56PM o 7 �- ED i;,:iR -L , ; d MAR 182014 )NMEt ENVIRIONpWfT- YAkCL�HEALTH This permit is issued pursuant to all provtaions of City of Tracy Municipal Code. This permd i5'gr n& vgtlit'ttP�T express condition that the permittee shall be responsible for all claims and liiabTaies arising nut of wort( performed under the permit or arising out of permitfee's failure to perform the obligations with respect to street maintenance. The permittee shall,and by acceptance of the permitagrees to,defend,indemnify,save and hold harmless thacity, its officers and employees,from and against any and all suits,claims or actions brought by any person for or on account of any bodily fhjudes,disease or illness or damage to.persons andlor property sustained or arising In the constrvctibn of the Work performed under the permit or in consequence or permlttee's failure to perform the.obl.gations with respect to street maintmnarim- Permittee agrees to abide by the provisions ofthis permit. 9 PERMrrTEE'S SIGNATURE DATE Prior to excavation, Contraetormustcorrmct the following to have bvko ground facilities locaied(48hours prior to work): UNDERGROUND SERVICE ALERT Toll Free:(600)227-2600 Boyd Service Center (205)831-4420 Note: You are notified that Section 6500 of the Labnr:Code requires the issuance of a parmft by the Division of Industrial Safely of the State of California priorto the,construction of any trench or excavation which is five feet or deeper and into which a person is requned to descent Excavation in,city$heet areas wdlwut an excavation permit may be punishable by a fine. Permittee agrees thatthey hereby accept complete responsibility for coordination with,reporting to,and complying with the direction of,any and all boards or districts,including but not limited to,San Joaquin County Local Health District and California Regional Water Quality Control Board,orany other regulatory agency having jurisdiction or authority over soil orgmund Water contamination such as thatruirerdly fotpid at the site of this work, Including the preservation of the health and safety of persons working near or in anylrench or excavation or on the surface of the.construction project,or any persons passing by observing,orany parsons living in the vicmity.of the construction project,for any reason whatsoever that may adversely,or otherwise affect the:health or safety,now and in the future,", ase persons or group of parsons. Furthermore,permittee hereby socepts complete responsibility for disposal of any petroleum affected soils,or ground water,includh.V reporting to and complying with the requ'irernerdS of any,or all,of the stated,:or any other,regulatory agencies-as discussed above. CITY INSPECTOR'S CAMPt-ETION REPORT NUMBER- Date of Completion: concrete: Asphalt: Sidewalk- Backfill: Paving: Size of Cut Sq.Ft. Inches, Paved By: w. INSPECTOR SIGN OFF: Last updsted 9h712WS Page 2 of 2