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T 01/0G/2005 15.26 FAX 208 931..,30 CITY OF TRACY �,r �002/4a32 Page 2 of 7 � This permit is tssuod pursuprrt tra all provisions of City of Tracy Municipal t;odo.. Ti,:�permil,s grar,tec3 uprrn the express Ctmdillon that the permittee shall be responsible for ail claims and Wbiiities arising out of work performed under the permit or arising out of petmifiee"s failure to perform the obligations wit's ,,espect to street mer€ntenatace, The permittee shall, and by ooceplance of the permit agrees to,defend. indemnlfy, lave and hold NW11--ss.the city, its nff'rGers Arid employees,from and 1golAst any and all suite,claims or action i brought oy ank pe rson for or on account of any bodily injuries, dl &e or alines$of damage to pWsons andlor prop"suslainii-0 tel ori.ing in -� The i;;onstrtrGtiort of the mok performed under the permit or in consequence or pe�ta=else': feature to pe form the o abligataons with respect to street mainlenaracc. PepAr'L s to abide b the prQvisions of this permit__ W PFRMITTE SltaI ATURE ftA Prior to axcavalian, Contractor must contact the following to have below-ground fai ilrties located{4.#hares prior to work}: UNDERGROUND SERVICE ALERT t Toll Free. (800) 27-2800 l Boyd Serviot!Center (20g)831 +20 Now. You are notified that Section 6500 of the Labor Cade regatiros the issuancr�orf a permit by th,�Division of Industrial Safety of the State of Calllorniaa prior to tt°re construction of any tronch c-excavation Whicr is 1"Ne feet or d"per and into which a parson is required 10 descent. Excavetton in city street afIVrts without art dr Ca ration permit may to punishable by a fine. Perrrsi ave apreos that they hereby accept complete respon,ibitily for coa4n tion with; reporting to, an f complying with the three#ton of,any and all boardz or districts, inctuding but not limited to, SEn doaquin County Lo ml Health Rlr,trict and Colifornia Regional Nater owility Control Board, or any other regultal+rr+r agency having jur&diction or � authority over soil or ground water contamination such aS that currently found at tic s itc or this worl,.,it eluding the preservation of the health and sefoty of persons working near or in any lrcnrh or ex,,avation or on the r 0rfa v of { the constructfon project,or any persons posting by or ob"rving,or any persons fMng in the viainitp of the construction project, for any reason whatsoevor tint may adversely,Or Otherwise 0,'-i°ct the htlalttt tar slrtety, now and in the future,of these persons or group of persons. ForthorrTMore, pormittee hereby accept complete responsibility for ttlsposal of OnY POtroieUrn 4311(!cI(A t oils, or ground water,including reporting to and complying with the requiromarft of any,or all,of the staled,ear tiny ether, regulatory agencies as discussed above. i t CITY INSP t;TCaR'S Ct]MPLE.tION REPORT PERMIT hIUBVIf�I=R- t�"�""��'•� DATE OF COMPLETION:,� � CortcrDte: Asphalt: Sidewalk: Backfill: Paving: Size of Cut q. FL - ----- - Inches payed 13y: INSPECTOR SIGN OFF