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Ma r. 1$. 2014 1: 56PM ,aR MAR 18 2014 )NME:- ENVIRON_4 FAL HEALTH This permit is issued pursuant to all provisions of City of Tracy Municipal Code. This permit is1)n4Cit'tt T 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 ani against any and an suits, ciaims or actions brought by any person for or on account of any bodily injuries, disease or illness or damage to.persons andlor property sustained or arising in the construction of the work performed under the permit or in consequence or permlttee's fai'um to perform the obligations with respect to street maintenance. Pemittee agrees to abide bythe provisions of this permit, W' PZRMITTEE'S SIGNATURE DATE Prior to excavation, Contractor must contact the following to have bedow-ground facilities located (48 hours prior to work). UNDERGROUND SERVICE ALERT Toll Free; (800) 227-2600 Boyd Service Center (209) 831-4420 Nate: You are notified that Section 6500 of the Labor Code requires the issuance of s 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. Pannittee 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 bit not limited to, San.Joaquin County Local HBalth District and Galifornia 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 anytrench 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 construobon project, for any reason whatsoever that may adversely, or otherwise affect the heaft or safety, now and in the future, of these persons or group of persons_ Furthermore, permiltee hereby accepts complete responsibility for disposal of any petroleum effected soils, or groundwater, including reporting to and complying with the requiremenU of any, or all, of the stated, or any other, regulatory agencies as discussed above, CITY 1NSPECTOR'S.GOMPLETION RFPORT NUMBER - Date of Completion: Concrete: Asphalt: Backfill: Size of Cut Sq. Ft. Inches INSPECTOR SIGN OFF= Last updated &n7,'2oi19 Page 2 of 2 Sidewalk: Paving: Paved By: