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•'A���L+R Kf x=. <br /> i <br /> f 308 NOTT_FT_C y:rON F QRM <br /> STATE OF CALIFORNIA r--� <br /> ,� <br /> DEPARTMENT OF INDUSTRIAL RELATIONS SISTRI T DATE <br /> DIVISION OF' OCCUPATIONAL SAFETY AND HEALTH <br /> VO <br /> culonf 6500 6501 and 6502 df the CI1,larus labor Coda squire lhal ell fain Su0d1Y Ind ihli{t o omsionreview +nfatmakionnecesSa+y lO evaivalelhe llltlyCl <br /> oc blies wolhg by IAerr mentaOOSlinvolve hstsi abol si lfh of in WY rosy nol be the war�fdeWORMlapermit+edunaments Aparna+w�llno,be+ffuedunellevidenee <br /> oerldrmad+nuhou{ipaenwlffuadbyOpSlf IhelapgCadartaltttlelhallhaat7Pi+can{ hia been dfmanlulitd 1nII the ksu of emo+o meat will b <br /> D Y e laie snd hesUhiul <br /> Employer A z Ll�, z <br /> Project Safet,� Contact. <br /> Address p , J`�]�`� .. Employers Rep J l <br /> - <br /> 'L. CA, �] 7 Tule & Phone <br /> Phone. 2' �' 2 a.') — ] Contractor`s :.cense ;#• '' <br /> job Location Q `f `y' Fd PhP <br /> Office Phone 3I4� <br /> Major Cross Street �.,► 2e ,(�� No. of Employees <br /> City Starting Date Ci <br /> r County Completion Date J uuc= tl lqq Z <br /> TYPE OF jOB <br /> Instructions: The appropriate items must be completed ana signea by a person <br /> knowledgeable about the project for each Jobalte to be covered by a perm- it. Please <br /> fill in or check all blanks where appropriate. <br /> EXCAVATIONS/TRENCHES <br /> Depth I I I � <br /> -- I width 2 Total Length <br /> Ground Protection: Shoring Sloping Shields <br /> Project Description_ 2— e. <br /> . 1Gf �-ts <br /> - U. `� c av,a t t r <br /> - Gr�z , <br /> I hereby certiJr <br /> to the best of my knowledge the above information and assertions <br /> are true and cand the p :ant has knowledge and will comply with the foregoing. <br /> Signat es <br /> Titles � c. <br /> Dates 199 Z <br />