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07/05/01 09:46 FAX Q03 � A f This permit 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 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 1 city, its officers and employees, from and against any and ali suits, claims or actions brought by any person for or on account of any bodily injuries, disease or illness or damage to persons and/cc property sustained or arising in the construction of the worst performed under the permit or in consequence or permittee's failure to perform the obligations with respect to street maintenance. Permittee agrees to abide by the provisions of this f`� -- PERMITTEE'S SIGNATURE DATE Prior to excavation, Contractor must contact the following to have below-ground facilities located (48,hours prior ; to work), UNDERGROUND SERVICE AL5RT Toll Free: (800) 227-2600 Boyd Service Center (209) 831-4420. . Note: You are notified that Section 6500 of the Labor Code requires the issuance 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 person is required to descent. Excavation in city street areas without an excavation permit may be punishable.by a fine. I Permittee agrees that they hereby accept complete responsibility for coordination with, reporting to, and complying with the direction of. any and alf 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 at the site of this i work, including the preservation of the health and'safety of persons working 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 i vicinity of the construction project. for an} reason whatsoever that may adversely,.or otherwise affect the health or safety, now and in the future, of these persons or group of persons. } i Furthermore, permittee hereby accepts complete responsibility for disposal of any petroleum affected soils, or j ground water, including reporting to and complying with the requirements of any, or all, of the stated, or any other, regu4atory agencies as discussed above CITY INSPECTOR'S COMPLETION REPORT C: Date of Completion: Concrete: 1 Asphalt_ Sidewalk: Backfill: — - Paving: Size of Cut Sq. Ft. Inches Paved By: Comments Page 2 of 2