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FACILITY INCIDENT REPORT <br /> <br />ALL WORK AUTHORIZED UNDER PERMIT NO. SHALL CEASE <br />IMMEDIATELY UNTIL FURT-HER NOTICE BY THE CITY OF ELK RIVER. <br /> <br />Contractor <br /> <br />Address <br /> <br />Phone Number <br /> <br />Responsible Person on the Job Site <br /> <br />Time of Incident <br /> <br />Facility(s) Damaged <br /> <br />, Time Reported <br /> <br />Cause of Incident: Missed Locate <br />Notes: <br /> <br />, Date of Incident <br /> <br />Accident <br /> <br />Substantial Breach <br /> <br />The incident has been determined to be a substantial breach of the terms and <br />conditions of a state statute, ordinance, rule or regulation, or a material <br />condition of the permit. <br /> You shall provide a written plan acceptable to the city that will cure <br /> the breach. <br /> > All work authorized under your permit shall cease until this plan is <br /> approved by the city. <br /> ~ Failure to reasonably implement the approved plan shall be cause for <br /> immediate revocation of the permit. <br /> <br />The incident has been determined to be an accident that was not your fault. <br />Work authorized under the permit may resume. <br /> <br />City Agent and Title <br /> <br />Date <br /> <br />cc5.docs:\b&z\stever\cc5.doc <br /> <br /> <br />