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bubbl,2�l�5j, 08:,UF Ar, G <br /> 7 9Z68b1u0430 4 o SECOR + PAGE 04104 <br /> CITY OF TRACY �OG8/003 <br /> s � <br /> This permit is Issued pursuant to all provision$Of City of Tracy Municipal Code. This permit is granted upon the <br /> express Condition trial the permittee shall ba fesponsibte for all clalrna qnd liabihtle$arising out of work performed <br /> under the permit or arising out of permittee's failure to perform lite ify, save pile hold harmless the <br /> obligations with respect to streat maintenance. <br /> The permittee shall, and by acceptance of the permit agrees to,defend, inderrara <br /> City, its officers and employees, from and against any and all' clb'srrls or actions brought by any per5vn for or <br /> on aCCount of any bodily injuries, disease or illness or damage to Persons and/or property stistalnod yr arising in <br /> the construction of the work performed under the permit or in consequ+R+rfae or permittee's failure#o patfvrm the <br /> obligations with respect to street rnaintenance, <br /> Permittee agrees to abide by the provisions of this porrrit. <br /> RMITTEE'S SIGNR UT RE .. <br /> -. ...` <br /> . .—-�, .�� ; +D 5 �. <br /> ATE <br /> Prior to excavation, Contrartor must contact the following to have below-ground facilltles located(48 hours prior to <br /> any streat cutting); <br /> UNDERGROUND SERVICE ALERT <br /> TOlf Free; (800)227.2600 <br /> Boyd Service Center <br /> (209) 831-4420 <br /> Note: You are notified tliat rection 6500 of the Labor Coda requires the issuance of a psrmit by the Division of <br /> Industrial Safety of the Sfata of California prior to the construction of any trench or excavation which is five feet or <br /> creeper and Into which a person is required to descent. CxCavation in City street areas without an excavation <br /> permit may be punishable by sa fine. <br /> Permittee agrees that they hereby accept complete responsibility for coordination with, reporting to, aril cDmpiyittg <br /> with the direction of,anv and all boards or districts, including but not limited to, Son Joaquin County Local Health <br /> Qistdct and California Regional Water Quality Control Board, or any other reguiatory agsncy having Jurisdiction or <br /> authority over soil or ground water contamination such as that currently found at the site of this work, including the <br /> preservation of the health and safety of persons working near or in any trench or excavaVorj or on the surface of <br /> the construntfon project, or any persons passing by or observing, or any persons living in the vicinity of the <br /> construction project, for any reason whatsoever that may adversely, or otherwise affect the health or safety,now <br /> and in the future, cf these persons or group of persons. <br /> Furthermore, permittee hereby accepts complete responsibility for dispcsat of any petroleum affected svfls,or <br /> ground water, including reporting to and complying with the requirements of any,or air, of the stated, or any other, <br /> regulatory agencies as discussed above. <br /> CITY INSPECTOR'S C MPLETICON RPOnD f <br /> Date of Compfetion: <br /> INSPECTOR SIGNATURE <br /> Ea MENTS <br /> Page 2 of 2 <br />