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06/15/2005 08:47 9168610430 SECOR PAGE 04/04 uiy/ I,ireVu� ;1r rxr, 2ua u' ' +14iU CITY OF TRACT IR003/003 i ! This permit is Issued pursuant to ail provisions of City of"Tracy Municipal Code, This permit is granted upon the express condition that the permittee shalt 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 maintenanoa. 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, eldims or actions brought by any person for or on account of any bodily injuries, disease or illness or damage to persons and/or property sustained Qr 2rlsing in the construction of the work performed under the permit or in consequence or permittee's failure to perform the obligations with respect to street maintenance. Per-rnittc�e agrees to abide by the provisions of this pormit. PERMITTEE'S SIGNATURE DATE Prior to exCavation, Contractor must contact the following to have below-grounci facilitles located(46 hours prior to any street cutting), UNCIERGROUND SERVICE AI..ERT Toll Free: (800)227-2600 Boyd Servtce Center (209) 831-4420 Note: You are notified that Section 8500 of the tabor Code requires the issuance of a permit by the Oivision 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. Lxcavation in city street areas without an excavation permit may be punishable by a firie. Permittee agrees that they 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, or any other regulatory agency having jurisdiction or authority over soil or ground water 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 the construction project, or any persons passing by or observIng, or any persons living in the vicinity of the CGhstr'uotion project, for any reason whatsoever that may adversely,Or otherwise affect the health or safety,now and in the future,cf these persons or group of persons. Furthermore, permittee hereby accepts complete responsibility for dspcsal 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. CITYINISPECTOR'S COMPLETION REPORT r'-�- � 3 Date of Completion INSPECTOR SIGNATURE Rage 2 of 2