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07/26/2004 16:47 2094671"S 07/26/2004 14:51 FAX 209 51430 f 07/16/2064 11:14 20946713.16 AGE STOCKTON CITY OF TRACY `-./ ACE STIXXTUM Page 2 Of P. PAGE 03/03 Z 002/002 PAGE 63/03 This permit is issued pursuant to all provisions of City of Tracy Municipi1 Code. Tt is pemnit is grantee upon the express condition that.tho pemNttee ehall be responsible for ell claims and liabilities arising out of wort purtormed under the permit or arising out of permitfee's failure to perform the obligations with inspect to street mitintcnance. The permittee shall, mod by acceptance of the permit agrees to, defend, indemnify, save and hold hamJeiss the city. Its officori and employees, from and against sny and all sub, claims or octione bfought,by any person for or Or' account of any bodily Injuries, disease or illness or damage to persons and/or praperty sustained or arising In the construction of the work performed under the permit or in consequence or pear Mae's (allure to pal form the obligations with respect to street maintprianca, Penni r'A tp-abide by the provisions of this permit, --t T 'ap" — �J P&HM t r r_c otv,.r 7VRF DATE' , Prior to excavation, Contractor must contact the forbwing to have belovn.ground facOtlas IQCated (4$ hours prior to work): UNDITRGROUND SERVICE ALERT Toll Free: (300) 227-2600 Boyd Service Canter (Z09) 831..4420 Nae: You me not fled that section esoo of the Labor Code requires the issuance of a permit by the D vision of Industrial Safety of the Slate -Of Califomia prior to the cnnalructlofl of any trench or erpvstion which in ave feet or iieeper and Into which a person Is required to descent E,ucavatlon in al street areas without an excat ation permit may be punishable by a flne. I'Mrmittec agrees that they hereby arnept complete responsibility for rooniiniMon with, reporting to, and wmplytrig with the dinacbon of, any and all boards or districts, Including but not IlmRad to, San Joaquin County Loral Health District and CalfOmia Regional water Quality Control Board, or any other regulatory agency having jur adiction or authority over Soii or ground water contamination such as that currently found mt the Site of thin work, in �Iuoing the preservation of the health and safety of persono wonting near or In any trench or exc,avelon or on the sarmce of the construction project, or any persons passing by ar obsenirlg, or any persons living in the vicinity of he construction project for any reason whatsoaver that may adver-ely, or ottwywlse affect. the health or safr`ty, now land in illm.tuturp. of those persons or group of parsons. Furthermcm, permittee hereby gccepts complete rosponsibillty for di.spoaal of any petroleum affected s hila, or ground water, including reporting to and complying with the requirements of any, or ail, of the stated, or any other, regulatory agencies as discussed above. GfTY INSPECTOR'S COMpta,ETION REPORT P�F+�IVtIT Nt1M�� . � ,,P" DATE OF COMPLETION: ASPh4►t sackful: site of Cut SII. Ft., .INSPECTOR SIGN OFF Concrete; Sidewalk: Paving: Inches Paved By: