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10/08/01 16:29 FAX lou �../ NOW This permit issued pursuant to all provisions of C;ty Of T racy Municipal Cede. This permit is granted upon the express condition that the permittee shall be responsible for all claims and liabilities arising out of work performed under the permit or arising out ci permiitee's failure to perform the obligations with respect to street maintenance. The permittee shall, anc 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 or or on account of any 5cgily injuries, disease or illness or damage to persons and/or property sustained or arising in the construction of the work performed under the permit or in consequence or permittee's `allure to perform the obiigations wiih respect to street maintenance. Permittee agrees to abide by 'he provisions of this permit. PERMITTii E 'S SIGNATURE /la'ATE Prior to excavation, C�ntrac'gr , .est cgntac; the fclicwing to have below-ground facilities ;coated (48 hours prior to work): UNDERGROUND SERV ICEALIEN Toll Free: (800) 227-2600 Boyd Service Center (209) 83'_420 Note: You are nctifiea that Secticn 6600 of the Labor Code requires the issuance of a permit by the Division of Industrial Safety of-he State of California prior to the construction of any trench or excavation which is five feet or deeper and into which a person is recuired to descent. Excavation in city street areas without an excavation permit may oe punis}^.dote ny a `ir.e. Permittee agrees that they hereby accept Comclete responsibility for coordination with, reporting to, and complying With the direction or, any and ail boaras or districts, including but not limited to, San Joaquin County Leca1 Health District and Cziifcrnia Regicnai'Nater Cualiiy Control Board, or any other regulatory agency having jurisdiction or authority over soil or ground•mater contamination such as that currently found at the site of this work, including :he eraser,,aticn of:he i-ieaith and safety of persons working near or in any trench or excavation or cn the sur-,ace of'he --:cnstruc;cn rciec;. or any ?arsons passing by or observing, or any persons living in the vicinity of the construc;ion prclec.. ;cr any reascr Whatsoever that may .adversely, or otherwise affect the health or safety, now anc ',n the 'uture, :�f:hese -,erscns 3r group of persons. Furthermore, permittee herecv accepts complete responsibility for isposal of any petroleum affected soils, or ground water, inc:uaing reporting e and ccmpiving with the requirements of any, or ail, of the Stated, or any other, regulatory agencies as discussed aoove. C S T N REFrP.7 IN rEC R'S i41F1 - 'O Date of COMC;Iet cn: Concrete: �3ptlait: ;Sidewalk: Bacicill: Paving: Size of Cut Sq. Ft. i^c es Paved By: Comments: _ - . a2of �