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- C This permit is Issued pursuant to all provisions of..City of Tracy Municipal Code. This permit is granted Upon the s 1 express condition that the permittee shall be responsible for all claims and liabilities arising out of work performed under the permit or arising out of permittee's failure to perform the obligations with respect to.street maintenance. The permittee shall, and by acceptance of the permit agrees to, defend, indemnify,save and hold harmless the city, 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 injuries, disease or illness or damage to persons and/or property i sustained or:arising in the construction of the work performed under the permit or in consequence or permittee's j failure to perform the obligations with respect to street maintenance. Permittee agrees to abide by the p ovisions of this permit. i P MITTEE'S SIGNATURE DATE/ ti ' . I Prior to excavation, Contractor must contact the following to have below-ground facilities located(48 hours prior y to work): UNDERGROUND SERVICE ALERT Toll Free: (800)227-2600 Boyd Service Center (209)831-4420 Note: You are notified that Section 6500 of the Labor Code requires the issuance of a permit by the Division of Industrial Safety,of the State of California prior to the.construction of any trench or excavation which is five.feet or: deeper and into which a person is required to descent. Excavation in city street areas without an excavation permit may be punishable by a fine. Permittee:agrees that they hereby accept complete responsibility for coordination with; reporting.to, and. ;com.plyingiwith the.direction of,.any and all boards or distracts, including but.not limited to, San Joaquin.County. Local Health.District and California Regional Water Quality Control Board, or any other regulatory agency having jurisdiction or authority over soil or groundwater contamination such as that currently,found at the site of this..,. work, including the preservation of the health and safety of persons working near or in any trench or excavation or on the surface of th,e construction project, or any persons passing by or observing, or any persons living:in:the. vicinity of.the construction project, for any reason whatsoever that may adversely, or otherwise affect thebealth:. or safety, now and in the future, of these persons or group of persons, Furthermore,.per mitkee hereby accepts.complete responsibility for disposal of any petroleum:affected soils,or ground water, Including reporting to and complying with the requirements of any, or all, of the stated, or any other,regulatory agencies as discussed above. CITY IN$PECTOR'S:COMPLETION REPORT NUMBER- Date of Completion: Duration: j INSPECTOR SIGNATURE: i Remarks• I Last updated 3/1 9/2010. Page 2 of 2