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FILE No.281 09/24 '03 10:37 ID:CITY OF TRACY DEW & ENG FPX:209 331 4606 PAGE 3i 3 Page 2 of 2 This permit is Issued pursuant to all provisions of City of Tracy Municipal Code. 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 of permittse's failure to perform the obligations with respect to street maintenance. The permittee shall, enc by acceptance of The permit agrees to, defenG, indemnify, save and hold harmless the city, its offic®r=and employees, from and against any and all sults, claims or actions brought oy any person for or on account of any bodily injuries, disease or illness,or damage to persons and/or properly sustained or arising in the construction of the work performed under the permit or in consequence or permiRe©'s failure to perform the obligations with respect to street maintenance- Permittee agresas to ®bide by the p i61, ,on6 of this p/a m%t. �� --Z*� PERMITYEE'S SI ATURE DAT I: Prior to excavation, Contractor must contact the following to have below-ground facilities located (48 hours prior to work): UNDERGROUND SERVICE ALERT Toll Free: (000)227-2600 Boyd Service Center (209)831-4420 Note: You are natIfted that Section 6600 of the Labor Code raquires the issuaneb 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 parson is required to 6e6cent. Excavation In city street area& Without an excavation permit may be punishable by a fine. Permittee agrees that they hereby accept complete resiiponSIMIRy 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 sat trle site of this work, including the preservation of the health and safety of persons worMnsn 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 oonstruction project, for any reason whatsoever that maty adversity, or otherwiso affect the health or safety, now and in the future, of these persons or group of persons. Furthermore, perrrtittea hereby accepts complete reaponsibiiity for disposal of any petroleum affeexed 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 discussad Obove. CITYly4SPECToe'la COMPLEIT TION REPORT PERMNUMBER— 03 ,7e Z DATE OF COMPLETION- Concrete_ Asphalt, Sidewalk: Backfill: Paying: Size of Gut Sq. FL . Inches _ Paved By: INSPECTOR SIGN OFF 2098314430 => 08/27'03 15 :25